Fungal pulmonary valve endocarditis masquerading as a pulmonary embolism

Area of Science:

• Cardiology
• Pulmonology
• Infectious Diseases

Background:

• Septic pulmonary emboli (SPE) are often misdiagnosed as thromboembolic pulmonary embolism (TPE), especially in patients with a history of intravenous drug abuse (IVDA).
• Differentiating these conditions is crucial for appropriate treatment and patient outcomes.

Purpose of the Study:

• To present a case of fungal pulmonary valve endocarditis causing right ventricular outflow obstruction that mimicked chronic pulmonary embolism in an IVDA patient.
• To highlight the diagnostic challenges in distinguishing SPE from TPE in complex cases.

Main Methods:

• Case report presentation.
• Clinical diagnosis based on patient history, symptoms, and imaging.
• Surgical intervention and pathological findings.

Main Results:

• A patient with a history of IVDA presented with failure to thrive, initially presumed to have recurrent pulmonary embolism.
• Investigation revealed fungal pulmonary valve endocarditis leading to right ventricular outflow tract obstruction.
• Surgical intervention included pulmonary valve replacement and right ventricular outflow tract repair.

Conclusions:

• Fungal pulmonary valve endocarditis can present insidiously, mimicking chronic pulmonary embolism in high-risk populations.
• A high index of suspicion and comprehensive diagnostic workup are essential for accurate diagnosis and management.
• This case underscores the importance of considering infectious etiologies in patients with suspected pulmonary embolism and a history of IVDA.