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Case Report: Heart Transplantation for Refractory Candida tropicalis Endocarditis: A Case Report and Literature
Ricardo El Nouwar1, Eva Larranaga Lapique1, Frédéric Vanden Eynden2
1Clinic of Infectious Diseases, Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium.
Insights
Refractory fungal endocarditis, a serious heart infection, poses treatment challenges. Heart transplantation offers a life-saving option for patients unresponsive to antifungal medications.
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation
Background:
- Infective endocarditis caused by Candida species presents significant therapeutic challenges and high mortality rates.
- Standard antifungal treatments, including anidulafungin, fluconazole, and caspofungin, are often insufficient for complex cases.
Observation:
- A patient with Candida prosthetic valve endocarditis demonstrated resistance to multiple standard antifungal therapies.
- Literature review indicated limited successful heart transplantations for fungal endocarditis compared to bacterial cases.
Findings:
- Successful treatment of refractory Candida prosthetic valve endocarditis was achieved through heart transplantation.
- The patient remained infection-free two and a half years post-transplantation.
Implications:
- Heart transplantation should be considered a viable last-resort treatment for select patients with refractory fungal endocarditis.
- This case highlights the potential of heart transplantation in managing life-threatening, treatment-resistant fungal infections of the heart valves.
Abstract:
Candida infective endocarditis presents therapeutic challenges with high mortality. A complex case of Candida prosthetic valve endocarditis refractory to standard antifungals (anidulafungin and fluconazole) and high-dose caspofungin was successfully treated with heart transplantation. The literature review revealed a few cases of bacterial endocarditis successfully treated with heart transplantation, but with only two transplanted cases of fungal endocarditis. This report explores heart transplantation as a last resort for managing refractory infective endocarditis. The patient is still alive and free of infection, two and a half years after transplantation.
