title: Candida kefyr endocarditis in a patient with hypertrophic obstructive cardiomyopathy.
abstract: We report an uncommon but emerging fungal pathogen, Candida kefyr, as a causative agent of infective endocarditis in a patient with a known history of hypertrophic obstructive cardiomyopathy. A 74-year-old woman with diabetes type II, hypertrophic obstructive cardiomyopathy, presented with gross hematuria and abdominal pain. Computed tomography scan revealed a hemorrhagic mass in the superior pole of the right kidney, with a thrombus extending from the ureter to the bladder. She underwent cryotherapy of the renal mass, together with retrograde ureteral stent placement, developed hypotension and respiratory distress, spiked high-grade fever, and had a new pansystolic murmur over the mitral and aortic areas. Urine and blood culture grew C. kefyr. Transthoracic echocardiogram revealed large mitral valve vegetation with moderate regurgitation. Micafungin was started, patient responded, and fungemia cleared. Repeat echocardiogram showed small vegetation, preserved leaflet mobility and mild regurgitation. Patient received 10 days of micafungin, followed by 6 weeks of fluconazole.
authors.affiliation: Wayne State University, Detroit, Michigan 48201, USA. teenadmc@yahoo.com
authors.forename: Teena
authors.initials: T
authors.lastname: Chopra
authors.forename: Ashish
authors.initials: A
authors.lastname: Bhargava
authors.forename: Sachin
authors.initials: S
authors.lastname: Kumar
authors.forename: Anita
authors.initials: A
authors.lastname: Chopra
authors.forename: Sorabh
authors.initials: S
authors.lastname: Dhar
authors.forename: Luis
authors.initials: L
authors.lastname: Afonso
authors.forename: Jack D
authors.initials: JD
authors.lastname: Sobel
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000150:complications*; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications*; D054714:Echinocandins / Q000627:therapeutic use; D004696:Endocarditis / Q000150:complications* / Q000382:microbiology*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery; D055666:Lipopeptides / Q000627:therapeutic use; D000077551:Micafungin
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D015725:Fluconazole; D000077551:Micafungin