(Circulation. 1998;98:90-91.)
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Candida tropicalis Endocarditis
J. G. Gerritsen, MD;
J. T. van Dissel, MD, PhD;
; H. F. Verwey, MD, PhD
From the Departments of Cardiology and Infectious Diseases, University
Hospital Leiden, and the Department of Cardiology (J.G.G.), Hospital De
Weezenlanden, Zwolle, the Netherlands.
Correspondence to J.G. Gerritsen, Hospital De Weezenlanden, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, Netherlands.
A 73-year-old man
presented with weakness, weight loss, fever, and disorientation
of 3 weeks' duration.
Three months earlier, a transurethral prostatectomy had been
performed elsewhere. After surgery, the patient developed urosepsis
caused by Escherichia coli that was treated with amoxicillin
and gentamicin. Also, a Candida species had grown in urine
and 1 blood culture. However, no treatment was started against
Candida, and species determination was not performed.
When the patient was admitted to our hospital, some splinter
hemorrhages and conjunctival petechiae were found. The blood
pressure was 115/60 mm Hg, and the pulse was strong and regular
at 80 bpm. A holosystolic cardiac murmur was heard over the
precordium, with a diastolic component compatible with
aortic regurgitation. Transthoracic
echocardiography showed a large, oscillating
vegetation on the aortic valve(Figures 1
and 2,
large arrow; Ao indicates aorta ascendens) and an abscess in the aortic
root (Figure 2, small arrows). Blood cultures were positive after 1 day
for a Candida species that subsequently was shown to be
C tropicalis. Treatment had already been started
with amphotericin-B 0.6 mg · kg-1
· d-1 IV and flucytosine 25 mg/kg IV 4
times daily.
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Figure 1.
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Figure 2.
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Awaiting valve replacement with a suitable homograft, the patient
suddenly became severely hypotensive (systolic blood pressure
<60 mm Hg) and lost consciousness. Reanimation attempts failed.
Echocardiography performed during reanimation
revealed that the vegetation had herniated through the aortic valve and
completely obstructed the left ventricular outflow
tract.
Postmortem examination confirmed the clinical diagnosis . . . [Full Text of this Article]
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