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Does Heart Failure Mask Candida Tricuspid Endocarditis?
Anas Mahmoud1, Alman B Khalid1, Alejandra Ehle1
1Internal Medicine, St. Joseph's University Medical Center, Paterson, USA.
Cureus
|June 14, 2023
Summary
Fungal infective endocarditis, though rare, has the highest mortality. This case highlights a Candida species infection in a patient with multiple cardiac conditions, emphasizing the need for vigilant follow-up after valve replacement.
Area of Science:
- Cardiology
- Infectious Diseases
- Mycology
Background:
- Infective endocarditis (IE) presents significant morbidity and mortality.
- Fungal IE, primarily caused by Candida species, exhibits the highest mortality rate among all IE cases.
- Patients with prosthetic valves, especially bioprosthetic, are at increased risk.
Observation:
- A 47-year-old male with a complex cardiac history (heart failure, prior valve replacement, AICD) presented with severe symptoms.
- Initial presentation mimicked sepsis secondary to pneumonia, but echocardiography revealed a large tricuspid valve vegetation.
- Blood cultures confirmed Candida species fungemia.
Findings:
- The patient received micafungin and was transferred for surgical intervention.
- Successful management of fungal IE requires prompt diagnosis and targeted antifungal therapy.
- This case underscores the challenges in diagnosing and managing fungal IE in patients with complex medical histories and prosthetic material.
Implications:
- Regular follow-up for patients with bioprosthetic valve replacement is crucial for early detection and prevention of endocarditis progression.
- Proactive monitoring can mitigate risks associated with prosthetic material and potential sources of infection.
- This case emphasizes the critical role of echocardiography and blood cultures in diagnosing rare but life-threatening fungal IE.
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