Mr Q, a 50-year-old Caucasian, was referred for evaluation of fatigue that had begun 3 months earlier. During the past 2 weeks, he had also had low-grade fever and chills. Five months before his visit with us, he had undergone valve replacement for aortic stenosis associated with a congenital bicuspid aortic valve. His postoperative course was complicated by the development of complete heart block, for which he underwent placement of an atrioventricular sequential pacemaker.