Fungal endocarditis, more than a surgical indication and echocardiographic findings. Case report
DOI:
https://doi.org/10.37615/retic.v9n1a11Keywords:
endocarditis, fungemia, heart valve diseases, risk factors, frailty syndrome, case reportsAbstract
Fungal infective endocarditis is a rare condition with a high mortality rate, in which cardiac imaging plays a fundamental role in diagnosis, risk stratification, and therapeutic decision-making. We present the case of an 82-yearold female patient with multiple comorbidities and frailty who presented with decompensated heart failure secondary to Candida auris infectious endocarditis involving the mitral valve. Transesophageal echocardiography showed a mixed echogenic cystic mass attached to the posterior mitral annulus, measuring 4.2 × 3.4 cm, with independent movement from the valve plane. In addition, moderate generalized hypokinesis and severe mitral regurgitation (IV/IV) were evident, with a vena contracta of 1.0 cm. Given the high surgical risk, social condition, and frailty, surgical management was ruled out, and antifungal treatment with caspofungin and fluconazole was initiated, continued long-term in palliative care. This case highlighted the importance of a comprehensive assessment of surgical risk and patient frailty in therapeutic decision-making, emphasizing the value of transesophageal echocardiography as a decisive tool for the diagnosis and management of fungal endocarditis, a complex entity that requires an individualized and multidisciplinary approach.
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Haouzi A, Khayata M, Xu B. Relevance of cardiac imaging in the evolving landscape of infective endocarditis management. Ther Adv Cardiovasc Dis. 2024;18. doi: https://doi.org/10.1177/17539447241305587
Bellamy S, Mirza M, Umar MF, Enyia J, Malik K, Ameen A, et al. Recurrent fungal endocarditis of the aortic valve: A challenging clinical scenario. Clin Case Rep. 2024;12(10):e9496. doi: https://doi.org/10.1002/ccr3.9496
Vieceli T, Giordani BM, de Magalhães GA, Serena GC, Aquino VR, Borges VS, et al. Candida Infective Endocarditis in Patients With Candida spp. Bloodstream Infection: Risk Factors and 1‐Year Mortality. Mycoses. 2025;68(2):e70032. https://doi.org/10.1111/myc.70032
Thompson III GR, Jenks JD, Baddley JW, Lewis JS, Egger M, Schwartz IS, et al. Fungal endocarditis: pathophysiology, epidemiology, clinical presentation, diagnosis, and management. Clin Microbiol Rev. 2023;36(3):e00019-23. https://doi.org/10.1128/cmr.00019-23
Jamil Y, Akinleye A, Mirzaei M, Lempel M, Farhat K, Pan S. Candida endocarditis: Update on management considerations. World J Cardiol. 2023;15(10):469. doi: https://doi.org/10.4330/wjc.v15.i10.469
Meena DS, Kumar D, Agarwal M, Bohra GK, Choudhary R, Samantaray S, et al. Clinical features, diagnosis and treatment outcome of fungal endocarditis: a systematic review of reported cases. Mycoses. 2022;65(3):294-302. doi: https://doi.org/10.1111/myc.13398
Cornely OA, Sprute R, Bassetti M, Chen SC, Groll AH, Kurzai O, et al. Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM. Lancet Infect Dis. 2025;25(5):e280-e293. doi: 10.1016/S1473-3099(24)00749-7.
Patel SK, Hassan SMA, Côté M, Leis B, Yanagawa B. Current trends and challenges in infective endocarditis. Curr Opin Cardiol. 2025;40(2):75-84. doi: https://doi.org/10.1097/HCO.0000000000001192
Østergaard L, Oestergaard LB, Lauridsen TK, Dahl A, Chaudry M, Gislason G, et al. Long-term causes of death in patients with infective endocarditis who undergo medical therapy only or surgical treatment: a nationwide population-based study. Eur J Cardio-Thorac Surg. 2018;54(5):860-6. doi: https://doi.org/10.1093/ejcts/ezy156
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Copyright (c) 2026 Juan Sebastián Cabrera Hernández, Álvaro Hernán Rodriguez Cerón
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