Prosthetic Aortic Valve Endocarditis Due to Candida glabrata Successfully Treated With Intravenous Micafungin Followed by Oral Fluconazole Without Surgery: A Case Report and Literature Review

TL;DR

A rare case of fungal infection on a prosthetic aortic valve caused by Candida glabrata was successfully treated with antifungal drugs without surgery.

Contribution

This is one of the few reported cases of C. glabrata prosthetic valve endocarditis treated successfully with non-surgical antifungal therapy.

Findings

The patient was treated with six weeks of IV micafungin followed by oral fluconazole.

The patient remained well at six months follow-up without needing surgery.

The case highlights the potential for medical management in high-risk patients unfit for surgery.

Abstract

Fungal endocarditis (FE) is an uncommon and life-threatening disease with unacceptably high mortality rates. Only a handful of cases of FE caused by Candida glabrata have been reported in the literature so far. We present a case of C. glabrata prosthetic valve endocarditis (PVE) in a 59-year-old woman with a history of prosthetic aortic valve who was admitted after outpatient blood cultures came positive for yeast (later identified as C. glabrata). A trans-esophageal echocardiogram showed vegetation on the prosthetic aortic valve. The patient was successfully treated with intravenous (IV) micafungin as she was deemed unfit for valve replacement surgery due to multiple high-risk comorbidities. The patient was treated with six weeks of IV micafungin followed by oral fluconazole for lifelong suppression, and she remained well at follow-up six months later. In this report, we review the latest literature on FE and discuss the role of antifungal therapy in its management.

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