Pyrexia in an older man, months after emergency

An 85 year old caucasian man presented to hospital with a three day history of feeling generally unwell. He had undergone emergency endovascular aortic aneurysm repair five months before presentation and had made a poor recovery, regaining limited function. On examination, he was febrile and drowsy with a Glasgow coma scale score of 13. Blood tests showed an elevated C reactive protein (250 mg/L, reference range <4) with a normal leucocyte count. His serum creatinine was 151 mmol/L (59-104) and albumin was 19 g/L (34-50). High sensitivity troponin I was raised at 2823 ng/L (<50), and there were no electrocardiographic changes suggestive of myocardial ischaemia and no history of chest pain. These features are suggestive of a type 2 myocardial infarction; however, blood cultures grew Staphylococcus aureus. The man underwent a computed tomography scan (fig 1).