A 65-year-old man was admitted to the Veterans Affairs Palo Alto Health Care System inpatient podiatry service for treatment of osteomyelitis of the left midfoot. Three weeks prior to hospital admission, he had undergone surgical amputation of the second digit of the foot. He had no complaints. On review of symptoms, he denied fevers, shortness of breath, cough, and chest pain. His medical history was significant for left ventricular failure with an ejection fraction of 35% measured by echocardiography, renal insufficiency, coronary artery disease, diabetes, and peripheral vascular disease. He was a lifelong nonsmoker. On physical examination, his temperature was normal and he appeared well. Examination of the left foot demonstrated cellulitis and surgical changes. The chest examination was remarkable for rales at the right base. The remainder of the physical examination was unremarkable. The peripheral blood leukocyte count was 11,700/μL. A foot wound culture was obtained that subsequently grew Staphylococcus aureus and diptheroids. The patient was started on a 6-week course of IV vancomycin, and surgical revision was planned.