A 54-year-old male patient presented with a 1-year history of fatigue, anorexia, nonproductive cough, intermittent fever, and progressive weight loss of 50kg. His medical history included a bicuspid aortic valve, for which he underwent bioprosthetic valvular replacement 9 years earlier and a subsequent replacement with a mechanical valve 5 years later after prolapse of the bioprosthetic valve. Other medical history included type 2 diabetes mellitus, coronary artery disease, and hypertension. His medications included metformin, warfarin, carvedilol, ferrous sulfate, and atorvastatin.