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[A case report of Candida prosthetic endocarditis: an autopsy review]
M Otaki1, M Kawashima, A Yamaguchi
1Department of Cardiovascular Surgery, Osaka National Hospital.
Abstract:
Most of the increasing numbers of cases of Candida endocarditis have developed after cardiac surgery. We report a case of Candida parapsilosis endocarditis after mitral valve replacement in a patient with no predisposing factors. In this report we mainly examined the pathological findings in this patient with postmortem examination. A woman, age 55, underwent valve replacement with a Björk-Shiley prosthesis for mitral stenosis. The spike fever occurred on the 22nd postoperative day and Candida parapsilosis was cultured from the blood. On the 76th day, a conscious disturbance with the right side hemiplegia was experienced. A CT scan revealed massive hemorrhagic infarction. Despite the intensive care the patient died of cerebral damage. Pathologic findings showed that the vegetation in the major orifice of the Björk-Shiley valve was composed of both necrotic debris and tissue, with Candida organisms being scattered throughout the interstices. Additionally there were also multiple myocardial abscesses with necrotic tissue.
Insights
This case study highlights Candida parapsilosis endocarditis following mitral valve replacement. Postmortem examination revealed extensive fungal growth and myocardial abscesses, emphasizing the severity of this rare cardiac surgery complication.
Area of Science:
- Cardiology
- Infectious Diseases
- Pathology
Background:
- Candida endocarditis is an increasing concern, particularly post-cardiac surgery.
- Mitral valve replacement is a common cardiac procedure.
- Predisposing factors are often associated with Candida endocarditis.
Observation:
- A 55-year-old woman developed Candida parapsilosis endocarditis after mitral valve replacement.
- The patient presented with fever, positive blood cultures for Candida, and neurological deficits.
- Cerebral infarction was identified via CT scan.
Findings:
- Postmortem examination revealed vegetation on the Björk-Shiley valve prosthesis.
- Candida organisms were found within the vegetation and myocardial abscesses.
- Pathology confirmed extensive fungal involvement and tissue necrosis.
Implications:
- This case underscores the risk of Candida parapsilosis in prosthetic valve endocarditis, even without typical risk factors.
- Detailed pathological findings offer insights into the mechanisms of fungal spread and tissue destruction.
- Early recognition and treatment are crucial for managing this life-threatening condition.