any ideas?? This little bug is driving me crazy. Previous hi | Figure 1

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any ideas?? This little bug is driving me crazy. Previous history of + blood cultures w/ #MRSA-(methicillin-resistant-Staphylococcus-aureus), diagnosed w/ #Endocarditis and #Tricuspid-valve removed. Image is a gram stain (slightly over decolorized) from the ground valve tissue. No growth on any plates under any conditions after 5 days. PT treated w/ #Vancomycin for 4 days prior to valve removal.

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patient with #MRSA-(methicillin-resistant-Staphylococcus-aureus) after removal of #Melanoma on the #Scalp. First picture is initial and second is 6 days later.](https://app.figure1.com/case-detail/0a8fac9f-9809-4bb0-8e9c-c1dc3b1e7056)

Respiratory and blood culture growing Pan-R #Acinetobacter. Colistin, tigecycline and rifampin sensitivities pending. Penicillin allergy (hives). CrCl 30mL/min and on the decline, intubated & in ICU, hx of many ICU days, on vancomycin for MRSA / Gram positive coverage.... What would u do? Is there a "right" answer? I like colistin IV+INH w/ meropenem extended infusion. Life > kidneys.](https://app.figure1.com/case-detail/0b4cad54-178c-41d8-9bca-cc72a35e0dd5)

22 yo w truncus s/p aortic and pulmonic valve grafts w hemothorax and ?necrotic lung](https://app.figure1.com/case-detail/5af9a2f4-e42f-40a8-81b4-78c7cdcbae5e)

36 y/o F w/PMH of SLE p/for mitral valve replacement.
Pre-operative echo showed severe mitral regurgitation and non-specific thickening of the mitral leaflets.
In-op examination of the valve showed several verrucous vegetations attached to the subvalvular apparatus. The valve was removed and replaced with a mechanical prosthetic.
Pathologic examination of the mitral valve confirmed #Libman-Sacks endocarditis.](https://app.figure1.com/case-detail/96596d50-5b74-4f74-a1f7-234d25ca6cd1)

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.
He had a history of hypertension, long-term smoking, and a sedentary lifestyle.
On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.
Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)