Dear Editor,

A 49-year-old heterosexual man was admitted after three episodes of loss of consciousness. He had received a diagnosis of HIV infection in 2002 and was virologically suppressed on Biktarvy (CD4 count 499/mm3, nadir 302/mm3). Medical history comprised Staphylococcus aureus endocarditis and mitral valve replacement in 2011, followed by daily warfarin. The same year, he was diagnosed with bacterial meningitis secondary to acute otitis. No history of intravenous drug use was known.

On admission, he reported night …