Late recurrent Candida endocarditis.
Late recurrent Candida endocarditis (LRCE) developed on a prosthetic mitral valve 22 months after treatment for primary native mitral valve endocarditis. The LRCE was difficult to diagnose; results of two dimensional echocardiography and repeated blood cultures were negative. Only transesophageal echocardiography revealed a vegetation and only lysis centrifugation blood cultures demonstrated candidemia. Postmortem examination revealed a large Candida vegetation on the prosthetic valve and Candida in the mitral valve ring. This case and a review of the literature indicate that Candida endocarditis treated with amphotericin B and prosthetic valve replacement may recur months after treatment, and that LRCE, which is difficult to diagnose and treat, may be best prevented by lifelong antifungal suppressive therapy.
Johnston
P G
PG
Medicine Branch, National Cancer Institute, National Institutes of Health, Bethesda 20892.
Lee
J
J
Domanski
M
M
Dressler
F
F
Tucker
E
E
Rothenberg
M
M
Cunnion
R E
RE
Pizzo
P A
PA
Walsh
T J
TJ
D000328:Adult; D002177:Candidiasis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D004696:Endocarditis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D013997:Time Factors; D014463:Ultrasonography