63M with significant PMHx of dilated cardiomyopathy and implanted cardiac resynchronization therapy pacemaker was admitted for general weakness, fevers and the skin lesions found below. Vitals in the ED were 82/58, HR 111, 38.8C. Labs revealed WBC 15, BUN/Cr 38/1.63 (previously normal baseline). CXR was within normal limits, urine was sterile. Began on IV ceftriaxone and vancomycin. Fevers persisted and blood cultures were negative. What is the next test/procedure you'd like to order and why?
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Internal Medicine
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Hi all, thanks for your answers! Patient underwent a TEE and was found to have three hypoechoic formations on the pacemaker electrodes. One month ago on TEE there was only one hypoechoic formation. He had to undergo pacemaker explantation.