Abstract
BackgroundFungal mural endocarditis is a rare entity in which the antemortem diagnosis is seldom made. Seven cases of mural endocarditis caused by Candida spp. have been collected from literature and six of these patients died after treatment with amphotericin B.Case presentationWe report a case of mural endocarditis diagnosed by transesophageal echocardiogram and positive blood cultures to Candida parapsilosis. Because blood cultures continued to yield C. parapsilosis despite caspofungin monotherapy, treatment with voriconazole was added.ConclusionThis is the first description of successful treatment of C. parapsilosis mural endocarditis with caspofungin and voriconazole.
Highlights
Fungal mural endocarditis is a rare entity in which the antemortem diagnosis is seldom made
In a review of 152 cases of fungal endocarditis reported between 1995 and 2002 [1], Candida species were recovered in 94.1% of yeast infections and Aspergillus species in 71.8% of mold infections
We present a case of Candida parapsilosis mural endocarditis cured by combined treatment with caspofungin and voriconazole
Summary
Fungal endocarditis has increased in incidence during the last 2 decades. In a review of 152 cases of fungal endocarditis reported between 1995 and 2002 [1], Candida species were recovered in 94.1% of yeast infections and Aspergillus species in 71.8% of mold infections. Ten previous cases of Candida endocarditis treated with caspofungin have been reported [16,17], four of which cured without cardiac surgery [17,18,19,20] This patient with C. parapsilosis mural endocarditis was cured by combined treatment with caspofungin and voriconazole. In the 7 cases of mural endocarditis caused by Candida spp. previously reported in the literature, 6 patients died after treatment with amphotericin B [8,9,10] and the only survivor was treated with combined azole therapy (alternating miconazole and fluconazole) and excision of the two mobile pedunculated masses in the right ventricle [11]. Relapsing endocarditis seems unlikely, the patient has been followed for less than 2 years and late relapse is still possible
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