Diagnostic Challenge of Fungal Prosthetic Valve Endocarditis: A Case Report

Introduction: Fungal prosthetic valve endocarditis is an extremely severe form of infective endocarditis, with poor prognosis and high mortality rate of about 50%. To better characterize this syndrome, we present a case of fungal prosthetic valve endocarditis due to Candida albicans following aortic valve replacement.

Case Presentation: A 43-year-old male patient with history of aortic valve replacement, complicated with three thoracic empyema who have been drained, presented to emergency with high fever, cough, sputum and dyspnea. Transthoracic echocardiography evaluation demonstrated that the aortic prosthetic valve was dysfunctional and the leaflets were immobile with the existence of a very mobile and huge vegetation attached to this one measuring 22×12mm. the first blood cultures were all negative and the patient was treated initially for bacterial endocarditis with no noted clinical or biological improvement. Moreover, the patient presented several complications: left kidney infarction, impaired renal function and rhythmic complications, ventricular tachycardia (VT). On the 17th day of hospitalization, a fungal pathogen type Candida Albicans was isolated from a culture of the patient's blood. Fluconazole was given intravenously for about 2 weeks. Since fever continued, C-reactive protein (CRP) remained elevated and no reduction in the size of vegetation was observed, a surgical intervention was planned. The vegetation was removed and replacement of the aortic valve by a new mechanical prosthetic valve was performed. 24 hours after the surgery, patient died of a sepsis.

Conclusion: Fungal prosthetic valve endocarditis is rare, but fatal. The diagnosis and management are challenging. Any patient who fails to respond to antifungal agents should be referred to cardiac surgery. Some of these patients may require radical debridement and/or valve replacement. However, even with surgical treatment, survival rates are low.