Late Failure of Surgical Treatment for Bioprosthetic Valve Endocarditis Due to Candida tropicalis

• Published in: Clinical infectious diseases 1996-02, Vol.22 (2), p.380-380
• Main Authors: Mansur, Alfredo José, Safi, Jorge, Paulista Markus, Marcello Ricardo, Aiello, Vera Demarchi, Grinberg, Max, Pomerantzeff, Pablo Maria A.
• Format: Article
• Language: English
• Subjects: Aortic Valve; Biological and medical sciences; Bioprosthesis - adverse effects; Brief Reports; Candida tropicalis; Candidiasis - drug therapy; Candidiasis - surgery; Endocarditis; Endocarditis - drug therapy; Endocarditis - surgery; Heart Valve Prosthesis - adverse effects; Heart valves; Human mycoses; Humans; Infections; Infectious diseases; Male; Medical sciences; Middle Aged; Miscellaneous mycoses; Mitral Valve; Mycoses; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - surgery; Prosthetic heart valves; Prosthetics; Recurrence; Relapse; Surgical specialties; Ungulates; Vegetation
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/clinids/22.2.380

We report a case of Candida tropicalis endocarditis in a patient who was not an intravenous drug user; this patient had a probable relapse 44 months after surgery. A 50-year-old man with chronic rheumatic valvular disease underwent aortic valvuloplasty and mitral valve replacement with a bovine pericardial bioprosthesis. Routine culture of the implanted prosthesis was sterile. After the operation, mild aortic insufficiency was noted; fever, pericardial and pleural friction rubs, and atrial fibrillation ensued. The diagnosis of postpericardiotomy syndrome was made, and treatment with indomethacin (150 mg daily) was initiated. The patient defervesced and was discharged. The fever relapsed after therapy with indomethacin was discontinued, and the patient was readmitted to the hospital 73 days after discharge (81 days after surgery). After blood for cultures was drawn, therapy with penicillin and streptomycin was started; however, seven of eight sets of blood cultures later yielded C. tropicalis. Antibiotic therapy was changed to that with amphotericin B, and the patient underwent surgery 2 days later. The bioprosthesis and the value were replaced with two bovine pericardial prostheses. Culture of the excised prosthesis yielded Candida species, although culture of the aortic valve was sterile. Histologic examination of sections of the prosthesis revealed numerous hyphae and spores compatible with a Candida species. A total dose of 2.1 g of amphotericin B (50 mg/d) was administered over 6 weeks. The patient was discharged on the 59th postoperative day, and no evidence of metastatic infection was detected on follow-up.