Images in Clinical Medicine
Fungal Prosthetic-Valve Endocarditis
N Engl J Med 2001; 344:275January 25, 2001
- Article
Figure 1 A 77-year-old man presented with a two-month history of fever, chills, and malaise. Three months earlier, he had undergone valve replacement for calcific aortic stenosis at another institution. Multiple subsequent blood cultures were positive for Candida albicans. Clinical signs of endocarditis (new murmurs, splenomegaly, Osler's nodes, and retinal lesions) were absent. Transesophageal echocardiography identified a mobile vegetation within the leaflets of the prosthetic valve that prolapsed into the ventricle during diastole. The patient was treated with amphotericin B and flucytosine for two weeks. At reoperation, the prosthetic valve (Panel A) contained a whitish vegetation (V) attached to the leaflets (L). The vegetation extended into the left ventricular outflow tract (LVOT) when a valve leaflet was opened (Panel B). A photomicrograph of the vegetation demonstrated innumerable candidal elements, including pseudomycelia (P), blastospores (B), and chlamydospores (C) (Panel C; silver stain, ×40). The prosthetic valve was removed, and an aortic-valve homograft was implanted (i.e., a “mini-root” replacement) to reconstruct the heart. Postoperatively, the patient received liposomal amphotericin B and flucytosine followed by oral fluconazole, and the sepsis cleared.
Ishik C. Tuna, M.D.
Michael R. Harrison, M.D.
Evansville Heart Center, Evansville, IN 47710- Citing Articles (1)
Citing Articles
1
William J. Steinbach, John R. Perfect, Christopher H. Cabell, Vance G. Fowler, G. Ralph Corey, Jennifer S. Li, Aimee K. Zaas, Daniel K. Benjamin. (2005) A meta-analysis of medical versus surgical therapy for Candida endocarditis. Journal of Infection 51:3, 230-247
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