Fungal endocarditis of the aortic valve complicated by recurrent embolic events

Fungal endocarditis is a rare but serious disease with a high mortality rate, affecting mainly young patients. A 46-year-old man underwent emergency thromboembolectomy with a diagnosis of thromboembolism of the right femoral artery. During investigation into cardiologic causes, his fever was 37.8 °C and he had a 2/6 systolic ejection murmur. Echocardiography revealed a vegetation, 1.2 x 0.8 cm in size, on the noncoronary cusp of the aortic valve. The vegetation was removed surgically and the aortic valve was replaced with a mechanical valve. Upon isolation of Candida albicans in the surgical specimens, a diagnosis of fungal endocarditis was made and parenteral fluconazole treatment was instituted. After surgery, the patient’s fever persisted and blood cultures were positive for C. albicans. Abdominal computed tomography performed for abdominal pain showed a pseudoaneurysm in the right iliac artery and a thrombosed aneurysm in the left iliac artery. Peripheral angiography revealed an aneurysm and occlusion in the right external iliac artery, total occlusion in the right common femoral artery, and an occlusion and dissection in the left external iliac artery. There was also an infarct area in the peripheral spleen, measuring 4 cm. The patient’s general condition showed a rapid deterioration and he died before any surgical intervention could be performed.