Candida-Induced Infective Endocarditis With Large Vegetation on a Bicuspid Aortic Valve in an Immunocompetent Patient

Introduction: Infective endocarditis (IE) is a life-threatening condition caused by microbial infection of the heart valves or endocardium. Fungal IE, predominantly caused by the Candida species, accounts for less than 2% of IE cases, and is usually associated with immunosuppression or other risk factors. This case report describes an unusual instance of Candida albicans endocarditis with extensive aortic valve vegetation in an immunocompetent patient, highlighting the challenges in diagnosis and management. Case Report: A 26-year-old active-duty soldier with no history of chronic illness presented with dyspnea, peripheral edema, and oliguria. Examination revealed a diastolic murmur, anemia, acute renal failure, and elevated inflammatory markers. Imaging showed cardiomegaly, pleural effusion, and a bicuspid aortic valve with large, mobile vegetations. Blood cultures confirmed C. albicans, and antifungal therapy with fluconazole was initiated. Despite aggressive medical management, including hemodialysis, the patient's condition deteriorated, and due to hemodynamic instability, surgery was not feasible. The patient unfortunately succumbed to complications. Discussion: Candida endocarditis is uncommon in immunocompetent individuals; biofilms enhance resistance against antifungal therapy and the immune response, even in immunocompetent individuals. The absence of conventional risk factors poses diagnostic challenges. The case also underscores the rapid progression and poor prognosis of fungal IE, particularly with extensive vegetations and hemodynamic instability. Conclusion: Candida endocarditis is a rare but severe condition, even in healthy individuals. This case emphasizes the importance of early recognition, comprehensive management, and further research to optimize outcomes in fungal IE.