Histoplasma capsulatum endocarditis cured by amphotericin B combined with surgery

A patient is reported who had Histoplasma capsulatum endocarditis, a rare form of disseminated histoplasmosis. He also had disseminated intravascular coagulopathy and defects in cell-mediated immune responses to Histoplasma antigens. Prompt etiologic diagnosis was made by stain of tissue from a mouth ulcer and confirmed by culture of the organism from blood. An echocardiogram compared to a previous normal echocardiogram indicated changes consistent with a vegetation. Histologic examination of the resected valve demonstrated organisms. Amphotericin B administration (3.4 g) plus an aortic valve replacement resulted in cure.