"Case 5-2007: A 53-year old man with a prosthetic aortic valve and recent onset of fatigue, dyspnea, weight loss and sweats" begins with the background - 4 years previously, the patient had had aortic valve replacement, which had to be repeated 3 months after the first surgery. 
 
Being heavily involved with consumer health these days, this portion of the narrative rather leaped out at me:
 
"Approximately 4 months before admission, the patient began to have anorexia, fatigue, and dyspnea on exertion, which gradually worsened, causing him to avoid climbing stairs. He reported profuse sweating during the day but no night sweats, fevers, or chills. He saw his primary care physician, who prescribed escitalopram for depression.
 
During the next 2 months, his symptoms continued, and he lost more than 22.7kg in weight....One month before admission, he again saw his primary care physician....Orally administered iron supplementation was begun."
 
Fortunately, the patient saw his cardiologist and had an echocardiogram, showing severe aortic insufficiency. The patient was diagnosed at Mass General with blood-culture negative endocarditis, probably due to C. burnetti.
 
Depression????
 
Sheila Thomas
Librarian
Delaware Academy of Medicine
Newark, DE
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