A 58-year-old man was admitted to the hospital with fevers, weakness, and dyspnea for 2 days. His medical history was significant for end-stage renal disease (dialysis three times weekly via arteriovenous [AV] graft), coronary artery disease status after myocardial infarction and stenting of a left anterior descending artery lesion 4 years prior, and ischemic cardiomyopathy with class III congestive heart failure. One year prior to this hospital admission, septic phlebitis and bacterial endocarditis related to an implanted cardioverter-defibrillator were treated with device removal, replacement of both aortic and mitral valves (St. Jude mechanical prostheses), prolonged antibiotic therapy, and long-term anticoagulation. Five days prior to hospital admission, a superficial skin abscess of the anterior chest wall was drained. He remained well until 48 h before presentation when dyspnea, weakness, and diffuse myalgias rapidly developed. He was febrile at a hemodialysis session, blood cultures were subsequently positive for methicillin-resistant Staphylococcus aureus (MRSA), and he was admitted.