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Embolic ST-elevation Myocardial Infarction from Candida Endocarditis

Amre Ghazzal1, Gauravpal S Gill1, Sohab Radwan1

  • 1Internal Medicine, MedStar Washington Hospital Center, Washington, USA.

Cureus
|May 30, 2020
PubMed

Insights

This rare case highlights Candida endocarditis in intravenous drug users, leading to ST-elevation myocardial infarction. Management of this complex condition involves antifungal therapy and careful consideration of anticoagulation and interventions.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Case Study

Background:

  • Infective endocarditis typically affects right-sided heart valves, with left-sided native valve involvement being uncommon, especially in intravenous drug users.
  • Candida species are a rare cause of infective endocarditis, further increasing the rarity of this case.

Observation:

  • The patient presented with ST-elevation myocardial infarction, a serious complication of infective endocarditis.
  • Embolic myocardial infarction, particularly from septic sources like Candida endocarditis, is associated with poorer outcomes.

Findings:

  • Management of Candida endocarditis with myocardial infarction requires antifungal therapy.
  • The use of antithrombotic therapy and anticoagulation is controversial due to significant risks of neurologic complications.
  • Percutaneous coronary interventions present challenges, with aspiration embolectomy noted as a potentially safer option than balloon angioplasty and stenting.

Implications:

  • This case underscores the complexity in managing rare instances of Candida endocarditis causing ST-elevation myocardial infarction.
  • Optimal treatment strategies require a multidisciplinary approach, balancing antifungal therapy with cautious consideration of antithrombotic and interventional options.
  • Surgical intervention remains an option for refractory cases or when valve replacement is indicated.

Keywords:
candida albicanscandida endocarditisembolic myocardial infarctioninfective endocarditis

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