Time	Events
21 April 2017	Anorexia; urinary urgency and frequency with history of poor glucose control (haemoglobin A1C 12%).
26 September 2017	Altered sensorium, weakness, and weight loss; subjective fevers with night sweats and urinary symptoms. Computed tomographic (CT) of the abdomen reveals an enlarged spleen with interval development of infarcts involving 50% of the spleen.
12 October 2017	Altered sensorium and metabolic derangements. Echocardiogram shows interval development of severe aortic bioprosthetic valve dysfunction/stenosis, significant calcification, and mild prosthetic regurgitation. Routine blood cultures obtained, which were subsequently negative for growth.
13 October 2017	Transoesophageal echocardiogram reveals bulky thickening of the prosthetic aortic valve leaflets with mobile components prolapsing into the ventricular side of the valve. Echolucency in the posterior aortic root concerning for perivalvular abscess. Patient initiated on empiric antibiotics.
14 October 2017	Dental radiograph revealed periapical lucency suspicious for abscess. Extraction of remaining teeth performed. Histoplasma urine antigen is positive. Patient initiated on intravenous liposomal amphotericin B.
17 October 2017	Patient develops acute kidney injury. Positron emission tomography/CT findings are consistent with abscess along the posterior margin of the aortic root. Antifungal therapy was discontinued.
18 October 2017	Coronary CT angiography revealed extensive vegetations on the aortic side of the prosthesis; calcification and severe disease of distal left main and proximal left anterior descending artery (LAD) with poor distal LAD targets for bypass.
19 October 2017	Progressively worsening kidney injury, worsening mentation, and embolic phenomenon in extremities.
21 October 2017	Fungal blood cultures obtained on day 2 are positive for Histoplasma capsulatum.
30 October 2017	Patient expires. Request for post-mortem declined by family.