CASE PRESENTATION: A 37 year-old male presented with a 2 week history of flu-like symptoms. Initial assessment disclosed fever to 101oF, severe thrombocytopenia, leukocytosis with neutrophilia, and acute renal failure. Blood cultures grew Streptococcus dysgalactiae ssp. equismilis (SDSE), and TEE revealed a 1.6cm tricuspid valve vegetation. His EKG was noteable for 1st degree AV block, which eventually progressed to a type II 2nd degree block with occasional complete block. With concern for infectious spread to the conduction system, the patient was taken emergently to the OR for radical debridement of the endocarditis. Despite appropriate antibiotics, repeat TEE performed 5 days post-op revealed a new mitral valve vegetation with perforations in the anterior leaflets. He was again taken emergently to the OR, requiring extensive reconstruction of the cardiac skeleton following a repeat debridement. Post-operatively, the patient became profoundly hypotensive, and spiraled into a seemingly refractory vasoplegic shock. Despite multiple pressors, he remained hypotensive, and IVIG was attempted as salvage therapy. Remarkably, his pressor requirements diminished as hemodynamics normalized over the following 2 days. An extensive infectious work-up was pursued prior to discharge, but all remaining cultures and serology returned negative.