Case Presentation: A 55-year-old woman with intravenous polysubstance abuse presented with a 1-week history of back pain, fever, and cough with blood-tinged sputum. Vital sign on admission showed tachycardia and hypotension but she responded well to fluid resuscitation. A pansystolic murmur grade 2 was noted. There was diffuse midline and paraspinal tenderness over the back. [...]