Endocarditis due to Candida albicans in an immunocompromised patient: A case report

Rev Iberoam Micol. 2023 Apr-Jul;40(2-3):31-34. doi: 10.1016/j.riam.2023.06.001. Epub 2023 Sep 26.

Abstract

Background: Fungal endocarditis is a low-frequency disease with a challenging diagnosis, as it can be mistaken with bacterial endocarditis. Fungal endocarditis causes higher mortality rates in immunocompromised patients. In the clinical practice, the endocarditis caused by fungi represents up to 10% of all infectious endocarditis cases and has a mortality rate of nearly 50%.

Case report: Here we present the case of a 53-year-old woman under corticosteroid therapy with a history of rheumatic heart disease, aortic valve replacement, and rheumatoid arthritis, who presented with fungal endocarditis caused by Candida albicans. Even though the patient received 3 years of antifungal prophylaxis with fluconazole, had valve replacement surgery, and received intensive care, the patient finally worsened and died.

Conclusions: Comorbidities and corticosteroid therapy predisposed the patient to acquire fungal endocarditis. This case highlights the importance of implementing procedures for the isolation and identification of fungi, and for carrying out antifungal-susceptibility testing, as well as establishing surveillance programs to identify infection-causing species and drug resistance patterns in hospitals. Moreover, designing and upgrading the algorithm for infectious endocarditis is the key to future improvements in diagnosis.

Keywords: Candida albicans; Endocarditis fúngica; Endocarditis infecciosa; Fluconazol; Fluconazole; Fungal endocarditis; Immunocompromised patient; Infectious endocarditis; Paciente inmunocomprometido; Pruebas de sensibilidad; Susceptibility tests.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones
  • Antifungal Agents / therapeutic use
  • Candida albicans
  • Candidiasis* / microbiology
  • Endocarditis* / diagnosis
  • Endocarditis* / drug therapy
  • Endocarditis* / etiology
  • Female
  • Fluconazole / therapeutic use
  • Humans
  • Middle Aged
  • Mycoses* / drug therapy

Substances

  • Antifungal Agents
  • Fluconazole
  • Adrenal Cortex Hormones