Fungal Endocarditis: A Successful Case with Medical Therapy Alone

Endocardite Fúngica: Um Caso de Sucesso da Terapêutica Médica Isolada

Abstract

Fungal endocarditis is a rare and potentially fatal condition,
usually caused by Candida and Aspergillus spp. There is a
higher incidence in immunosuppressed patients, patients with previous endocarditis, prosthetic valves or intracardiac devices. Antifungal therapy and surgical approaches are essential as curative intention and to avoid embolic phenomenon. Success cases are rare with medical therapy alone.

We present an 80-years-old male patient with a pacemaker
and prosthetic aortic valve, previously treated for bacterial endocarditis (without valvular intervention, but with
pacemaker replacement), who was diagnosed with fungal
endocarditis due to Candida metapsilosis. Although caspofungin and voriconazole were started there was persistent candidemia, leading to the replacement of antifungal, namely liposomal amphotericin B and flucytosine. Chronic suppression with itraconazole followed. The patient was submitted for electrode replacement, but valve intervention was not performed. During the hospital stay, multiple complications occurred but he was discharged with good evolution and no recurrence on follow-up.

This case raises the question about the role of valvular intervention on patients whose medical therapy alone is sufficient and could be considered for curative intention for fungal endocarditis.