This case centers on recurrent Streptococcus dysgalactiae bacteremia in a patient with a diabetic foot wound and multiple prosthetic valves, including prior mitral valve replacement and recent TAVR. The recurrent bacteremia, equivocal source attribution, and prosthetic valve history create a diagnostic problem where routine echo and foot imaging may not fully answer the question of endovascular infection.
The teaching portion reviews how TAVR-associated endocarditis differs from SAVR endocarditis in presentation, microbiology, and echocardiographic detection. It then discusses PET/CT for suspected endocarditis and other endovascular infections, including patient preparation, what radiology is evaluating, indications involving prosthetic valves, CIEDs, and LVADs, and the limited evidence for serial PET/CT monitoring.