CA SE This 39-year-old intravenous drug user (actively using cocaine on the date of admission) was admitted with cellulitis of the right arm after experiencing fevers for several weeks. He had been treated with outpatient antibiotics without relief ofeither associated chills or dizziness. Two sets of blood cultures were obtained on admission. A trans-thoracic echocardiogram demonstrated a 1-em vegetation on the ventral surface of the aortic valve. The patient left the hospi tal against medical advice but was readmitted 2 days later for antimicrobial therapy. Past medical history was notable for multiple hospital admissions for both cellulitis and abscesses primarily involving the patient’s arm. He had had mul. tiple drug rehabilitation treatment attempts without success. Physical examination demonstrated a thin, unkempt man in no acute dis tress with multiple needle track” marks on both his upper and lower extremi ties. No spl hemorrhages or signs of embolic phenomena were noted on inter the extremities. Cardiac exam was notable for a grade IVVI systolic murmur best heard at the left sternal border. The spleen tip was palpable.The right am had a 10-by-6-em excoriated area with surrounding induration Gram stain of an organism detected in both sets of the blood cultures obtained at admission is shown in Fig. I. Growth of the organism on a blood agar plate is shown in Fig. 2. The organism grew in broth containing 65% NaCl, hydrolyzed esculin in the presence of bile (ie, was bile esculin positive), and was catalase negative. 1. What type of infection does this patient have? 2. What organisms frequently cause this type of infection in intravenous drug users (VDUs)? What organism is causing his infection? Figure 1