Resolution of Severe Thrombocytopenia and Candida parapsilosis Infective Endocarditis With Fourth Open-Heart Surgery

Surgical treatment for infective endocarditis (IE) with severe thrombocytopenia is considered high risk and is often avoided.

A 67-year-old man with a history of 3 open-heart surgeries presented with fever and severe thrombocytopenia accompanied by a bleeding tendency. Blood cultures and transthoracic echocardiography confirmed IE of the aortic bioprosthetic valve caused by Candida parapsilosis. Despite appropriate antifungal medical therapy, blood cultures remained persistently positive, severe thrombocytopenia persisted, and the vegetation continued to enlarge, resulting in medially refractory IE. Surgical intervention was deemed essential, and the patient underwent a fourth open-heart surgery. Shortly after the procedure, blood cultures turned negative, and platelet counts improved dramatically. The patient was discharged home.

Severe thrombocytopenia in this case was likely caused by the fungal infection and vegetation formation.

Surgical treatment for medically refractory fungal IE can aid in infection control and result in significant improvement in platelet count.