Open Access Case report

A rare case of Candida parapsilosis endocarditis in a young healthy woman – case report

Mijomir Pelemiš1, Goran Stevanović1*, Lidija Lavadinović1, Snežana Matić2, Ivana Milošević1, Miloš Korać1, Svetislav Pelemiš3, Milan Nedeljković2 and Milica Prostran4

Author Affiliations

1 Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Bulevar oslobodjenja 16, 11000, Belgrade, Serbia

2 Clinic for Cardiology, Clinical Center of Serbia, Dr Koste Todorovica 8, 11000, Belgrade, Serbia

3 Clinic for Otorhinolaringology, Clinical Center of Serbia, Pasterova 2, 11000, Belgrade, Serbia

4 Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11000, Belgrade, Serbia

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Journal of Cardiothoracic Surgery 2013, 8:29  doi:10.1186/1749-8090-8-29

Published: 22 February 2013

Abstract

Disseminated fungal infections are still rare conditions, mostly caused by Candida spp. during immunosuppression. Infection of immunocompetent individuals is uncommon. Endocarditis is a rare manifestation during candidaemia, mostly in patients with prosthetic valves. Affection of previously unaltered valves is uncommon.

We presented a case of a young, previously healthy female patient with endocarditis, caused by Candida parapsilosis. The initial symptom, fever, was present four months before hospital admittance. She was febrile without other symptoms and during observation in a local hospital. After her condition deteriorated, she was transferred to the Institute for infectious and tropical diseases, Belgrade. Clinical findings on admission include petechial skin rash and moderate hepatosplenomegaly. Newly developed systolic murmur was noted, and Candida parapsilosis was isolated in multiple blood cultures. Echocardiography revealed 15 × 14 mm vegetations on the right aortic vellum.

She was treated with antifungal drugs (fluconasole, liposomal amphotericin B), and the affected valve was successfully replaced. The same strain of Candida parapsilosis was isolated from the intraoperative material of the valve.

There were no markers of immunosuppression or other conditions which could affect the immune system.

After a prolonged period of treatment she was successfully cured, and she received a long-term intermittent suppressive fluconasole therapy for the time being.

Keywords:
Native valve; Antifungal therapy; Post surgical treatment; Candidaemia; Candida endocarditis