A man in his 30s with a history of polysubstance misuse was admitted for a splenic infarct and later experienced a right-sided ischemic stroke. His blood cultures grew Enterococcus faecalis. Transesophageal echocardiography showed a quadricuspid aortic valve (QAV) (Figure, A, and Video) with moderate aortic regurgitation and multiple tissue-density masses on the inflow side of the leaflet cusps (Figure, B). He ultimately underwent successful surgical bioprosthetic aortic valve replacement with no postoperative complications.