A 69-year-old previously well woman who was retired, married, and caregiver to her chronically ill husband was taken to the emergency department by her daughter with an acute onset of confusion, disorientation, and generalized malaise. Her medical history included a remote history of angina, intermittent pleurisy, a total abdominal hysterectomy with bilateral salpingo-oophorectomy, and cataract surgery in the left eye. Her only medication was estrogen replacement. There was no illicit drug use, recent dental work, or indwelling venous catheter. The patient was admitted to the hospital for workup of altered mental status and eventually found to have bacterial endocarditis with methicillin-resistant S aureus. The bacterial isolate had an intermediate resistance to vancomycin hydrochloride (minimum inhibitory concentration, 4-8 μg/mL). Magnetic resonance imaging of the brain showed multiple bilateral acute ischemic changes, and echocardiography revealed mitral valve endocarditis.