Infective endocarditis due to Gram-negative, non-HACEK bacteria is a rare clinical entity. Even moreso, isolated pulmonic valve endocarditis accounts for less than 1.5–2% of all cases of infective endocarditis. These disease pathologies commonly occur in the setting of intravenous drug abuse, indwelling catheters or cardiac devices, or underlying structural heart disease. We present a unique case of pulmonic valve endocarditis in the setting of persistent polymicrobial bacteremia with Klebsiella pneumoniae and Citrobacter koseri with recent gastrointestinal instrumentation evolving into isolated pulmonic valve endocarditis.

GENERAL MEDICINE hair and mucosal depigmentation may be appreciated as well. 6 Tinea versicolor, a fungal skin infection, presents with multiple diffuse patches as well, most commonly presenting on the trunk. 7 For this specific patient, the localized area of depigmentation and recent steroid injection made iatrogenic cause the most likely etiology. OUTCOME AND FOLLOW UP Available therapies for De Quervain's tenosynovitis include rest, non-steroidal anti-inflammatory medications, wrist splinting, steroid injections and a combination of both wrist splinting and steroid injections. This patient was diagnosed with corticosteroid-induced hypopigmentation secondary to her recent injection. Proper anticipatory guidance was provided and the patient was reassured that her normal pigment should return with discontinuation of steroids. The patient was scheduled to follow up in four months for re-evaluation of her wrist. DISCUSSION Pigmentation of skin is dependent upon the amount and function of melanocytes. Skin hypopigmentation results from either a decreased number of melanocytes or an injury to the melanocytes' ability to properly transport

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