Large lobular filling defects seen on CT in keeping with vegetations of infective endocarditis. These were not seen on transthoracic echocardiogram (possibly due to metal artefact), but were later also demonstrated on transesophageal echocardiogram.
Blood cultures were initially negative but repeated cultures and further testing later demonstrated Aspergillus galactomannan. Impression was that this was therefore likely a case of fungal endocarditis.
Fungal endocarditis is uncommon but carries a poor prognosis. Vegetations are often large at diagnosis and rates of embolization are very high 1. It is not only difficult to diagnose but also difficult to treat.