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Nonsurgical treatment of Histoplasma endocarditis involving a bioprosthetic valve
D S Kanawaty1, M J Stalker, P W Munt
1Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Abstract:
Endocardial involvement associated with disseminated histoplasmosis has been infrequently documented, especially among patients with prosthetic valves. The therapeutic approach to these patients is also not yet clearly defined. A 54-year-old man with prosthetic valve endocarditis due to histoplasmosis was successfully treated with amphotericin B. A review of the literature suggests that the optimal form of therapy is likely a combination of surgical replacement of the involved valve and high dose amphotericin B. Successful therapy with amphotericin B alone may, however, be achieved if surgery is not a viable option.
Insights
Disseminated histoplasmosis rarely affects heart valves, especially prosthetic ones. Treatment with amphotericin B can be successful, but combining it with valve surgery is often optimal for prosthetic valve endocarditis.
Area of Science:
- Infectious Diseases
- Cardiology
- Mycology
Background:
- Disseminated histoplasmosis is a systemic fungal infection.
- Endocardial involvement, particularly with prosthetic valves, is uncommon.
- Optimal treatment for histoplasmosis affecting prosthetic valves remains unclear.
Observation:
- A 54-year-old male presented with prosthetic valve endocarditis caused by disseminated histoplasmosis.
- The patient received treatment with amphotericin B.
- Literature review on endocardial histoplasmosis was conducted.
Findings:
- Successful treatment of prosthetic valve endocarditis due to histoplasmosis was achieved with amphotericin B.
- Literature suggests a combined approach of surgical valve replacement and high-dose amphotericin B is likely optimal.
- Amphotericin B monotherapy can be effective when surgery is not feasible.
Implications:
- This case highlights a rare presentation of disseminated histoplasmosis.
- It provides evidence for successful amphotericin B treatment in prosthetic valve endocarditis.
- It informs therapeutic strategies for complex fungal endocarditis cases, balancing medical and surgical interventions.