The COVID-19 pandemic has forced higher education institutions to shift to nearly 100% online delivery of didactic coursework nationally. Beside the stress and isolation that many students experience simply due to the physical distancing requirements imposed by the crisis, students new to learning in an online environment may feel further isolated and disengaged from the course content.

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Background:Prosthetic valve endocarditis (PVE), a life threatening condition, may arise early or late after cardiac valve surgery. It poses a high morbidity and mortality threat if not promptly diagnosed and treated. Case presentation:We report an interesting case of a 47-year-old male with recurrent endocarditis who presented with a one day history of progressive shortness of breath and increasing bilateral lower extremity edema. Transthoracic echocardiography (TTE) showed decreased left ventricle function with regional wall motion abnormalities, tricuspid regurgitation, and vegetations on the aortic valve. Blood cultures grew Burkholderia cepacia (B. cepacia) a sensitive to cefepime and C. dubliniensis sensitive to caspofungin. The patient was successfully treated with IV caspofungin and IV cefepime for 6 weeks and discharged from the hospital to a skilled nursing facility (SNF) and then to a rehabilitation center. Although, cases of early PVE with B. cepacia have been reported previously, but to the best of our knowledge, this is the first reported case of late PVE with B. cepacia and C.dubliniensis in the medical literature. The subject of this article is to present our experience with this exceedingly rare case of late PVE.Conclusion: PVE is very rarely caused by B. cepacia and C. dubliniensis. Prompt management of PVE by appropriate therapy can significantly reduce the morbidity and mortality risk associated with PVE.