Candida dubliniensis in recurrent polymicrobial tricuspid endocarditis

Area of Science:

• Infectious Diseases
• Cardiology
• Mycology

Background:

• Infective endocarditis (IE) is a serious infection of the heart's inner lining, often affecting heart valves.
• Intravenous drug use (IVDU) is a significant risk factor for IE, particularly affecting the tricuspid valve.
• Recurrent IE poses a therapeutic challenge, often requiring complex management strategies.

Observation:

• A case of tricuspid infective endocarditis in an IV drug user is presented.
• Despite cessation of IV drug use, the patient experienced multiple recurrences of IE.
• Six distinct microorganisms, including a fungal species, were identified as causative agents across the recurrent episodes.

Findings:

• The patient experienced recurrent IE episodes caused by diverse microorganisms, indicating multiple portals of entry.
• One episode involved fungal endocarditis, specifically Candida dubliniensis.
• This represents the first reported case of recurrent IE involving Candida dubliniensis in an HIV-negative individual.

Implications:

• Recurrent IE in IVDU necessitates vigilant monitoring and consideration of diverse microbial etiologies, including fungi.
• The identification of Candida dubliniensis in this context broadens the understanding of fungal endocarditis pathogens.
• This case underscores the importance of addressing underlying risk factors and potential reinfection pathways in managing recurrent IE.