Fungal prosthetic valve endocarditis with mycotic aneurysm: Case report
Fungal prosthetic valve endocarditis is an extremely severe form of infective endocarditis, with poor prognosis and high mortality despite treatment. Candida albicans is the most common etiological agent for this rare but increasingly frequent condition.We present a case of fungal prosthetic valve e...
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doaj-f497565690bc4228ad08b7a0c6026dc22020-11-25T01:29:44ZengElsevierRevista Portuguesa de Cardiologia0870-25512016-09-01359495.e1495.e4Fungal prosthetic valve endocarditis with mycotic aneurysm: Case reportMariana Brandão0Jorge Almeida1Rita Ferraz2Lurdes Santos3Paulo Pinho4Jorge Casanova5Escola de Ciências da Saúde, Universidade do Minho, Braga, Portugal; Corresponding author.Centro de Cirurgia Cardiotorácica, Hospital de São João, Porto, PortugalServiço de Doenças Infecciosas, Hospital de São João, Porto, PortugalServiço de Doenças Infecciosas, Hospital de São João, Porto, PortugalCentro de Cirurgia Cardiotorácica, Hospital de São João, Porto, PortugalCentro de Cirurgia Cardiotorácica, Hospital de São João, Porto, PortugalFungal prosthetic valve endocarditis is an extremely severe form of infective endocarditis, with poor prognosis and high mortality despite treatment. Candida albicans is the most common etiological agent for this rare but increasingly frequent condition.We present a case of fungal prosthetic valve endocarditis due to C. albicans following aortic and pulmonary valve replacement in a 38-year-old woman with a history of surgically corrected tetralogy of Fallot, prior infective endocarditis and acute renal failure with need for catheter-based hemodialysis. Antifungal therapy with liposomal amphotericin B was initiated prior to cardiac surgery, in which the bioprostheses were replaced by homografts, providing greater resistance to recurrent infection. During hospitalization, a mycotic aneurysm was diagnosed following an episode of acute arterial ischemia, requiring two vascular surgical interventions. Despite the complications, the patient's outcome was good and she was discharged on suppressive antifungal therapy with oral fluconazole for at least a year.The reported case illustrates multiple risk factors for fungal endocarditis, as well as complications and predictors of poor prognosis, demonstrating its complexity. Resumo: A endocardite fúngica de prótese valvular é uma forma extremamente severa de endocardite infeciosa, com mau prognóstico e elevada mortalidade apesar do tratamento médico. Candida albicans é o agente etiológico mais frequentemente implicado nesta rara, embora crescente, patologia.Relata-se um caso de endocardite fúngica de prótese valvular após substituição das válvulas aórtica e pulmonar numa mulher de 38 anos com antecedentes de tetralogia de Fallot cirurgicamente corrigida, endocardite infeciosa prévia e insuficiência renal aguda com necessidade de hemodiálise por catéter. A terapêutica antifúngica com anfotericina B lipossómica foi iniciada previamente à cirurgia cardíaca, onde as biopróteses foram substituídas por homoenxertos, conferindo maior resistência à infeção recorrente. Durante o internamento, foi diagnosticado um aneurisma micótico, na sequência de um episódio de isquemia arterial aguda, obrigando a duas intervenções pela Cirurgia Vascular. Apesar das complicações, a doente teve um bom outcome clínico e recebeu alta com terapêutica de erradicação com fluconazol durante, pelo menos, um ano.O caso relatado enumera múltiplos fatores de risco para endocardite fúngica, assim como complicações e preditores de mau prognóstico, ilustrando a sua complexidade. Keywords: Fungal endocarditis, Prosthetic valve endocarditis, Candida albicans, Homografts, Mycotic aneurysm, Palavras-chave: Endocardite fúngica, Endocardite de prótese valvular, Candida albicans, Homoenxertos, Aneurisma micóticohttp://www.sciencedirect.com/science/article/pii/S0870255116301378 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mariana Brandão Jorge Almeida Rita Ferraz Lurdes Santos Paulo Pinho Jorge Casanova |
spellingShingle |
Mariana Brandão Jorge Almeida Rita Ferraz Lurdes Santos Paulo Pinho Jorge Casanova Fungal prosthetic valve endocarditis with mycotic aneurysm: Case report Revista Portuguesa de Cardiologia |
author_facet |
Mariana Brandão Jorge Almeida Rita Ferraz Lurdes Santos Paulo Pinho Jorge Casanova |
author_sort |
Mariana Brandão |
title |
Fungal prosthetic valve endocarditis with mycotic aneurysm: Case report |
title_short |
Fungal prosthetic valve endocarditis with mycotic aneurysm: Case report |
title_full |
Fungal prosthetic valve endocarditis with mycotic aneurysm: Case report |
title_fullStr |
Fungal prosthetic valve endocarditis with mycotic aneurysm: Case report |
title_full_unstemmed |
Fungal prosthetic valve endocarditis with mycotic aneurysm: Case report |
title_sort |
fungal prosthetic valve endocarditis with mycotic aneurysm: case report |
publisher |
Elsevier |
series |
Revista Portuguesa de Cardiologia |
issn |
0870-2551 |
publishDate |
2016-09-01 |
description |
Fungal prosthetic valve endocarditis is an extremely severe form of infective endocarditis, with poor prognosis and high mortality despite treatment. Candida albicans is the most common etiological agent for this rare but increasingly frequent condition.We present a case of fungal prosthetic valve endocarditis due to C. albicans following aortic and pulmonary valve replacement in a 38-year-old woman with a history of surgically corrected tetralogy of Fallot, prior infective endocarditis and acute renal failure with need for catheter-based hemodialysis. Antifungal therapy with liposomal amphotericin B was initiated prior to cardiac surgery, in which the bioprostheses were replaced by homografts, providing greater resistance to recurrent infection. During hospitalization, a mycotic aneurysm was diagnosed following an episode of acute arterial ischemia, requiring two vascular surgical interventions. Despite the complications, the patient's outcome was good and she was discharged on suppressive antifungal therapy with oral fluconazole for at least a year.The reported case illustrates multiple risk factors for fungal endocarditis, as well as complications and predictors of poor prognosis, demonstrating its complexity. Resumo: A endocardite fúngica de prótese valvular é uma forma extremamente severa de endocardite infeciosa, com mau prognóstico e elevada mortalidade apesar do tratamento médico. Candida albicans é o agente etiológico mais frequentemente implicado nesta rara, embora crescente, patologia.Relata-se um caso de endocardite fúngica de prótese valvular após substituição das válvulas aórtica e pulmonar numa mulher de 38 anos com antecedentes de tetralogia de Fallot cirurgicamente corrigida, endocardite infeciosa prévia e insuficiência renal aguda com necessidade de hemodiálise por catéter. A terapêutica antifúngica com anfotericina B lipossómica foi iniciada previamente à cirurgia cardíaca, onde as biopróteses foram substituídas por homoenxertos, conferindo maior resistência à infeção recorrente. Durante o internamento, foi diagnosticado um aneurisma micótico, na sequência de um episódio de isquemia arterial aguda, obrigando a duas intervenções pela Cirurgia Vascular. Apesar das complicações, a doente teve um bom outcome clínico e recebeu alta com terapêutica de erradicação com fluconazol durante, pelo menos, um ano.O caso relatado enumera múltiplos fatores de risco para endocardite fúngica, assim como complicações e preditores de mau prognóstico, ilustrando a sua complexidade. Keywords: Fungal endocarditis, Prosthetic valve endocarditis, Candida albicans, Homografts, Mycotic aneurysm, Palavras-chave: Endocardite fúngica, Endocardite de prótese valvular, Candida albicans, Homoenxertos, Aneurisma micótico |
url |
http://www.sciencedirect.com/science/article/pii/S0870255116301378 |
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