| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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
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 and
showed that a herniated fungal vegetation completely obstructed flow to
the ascending aorta (Figure 3
Footnotes
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine
Candida tropicalis Endocarditis
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.
View larger version (85K):
[in a new window]
Figure 1.
View larger version (92K):
[in a new window]
Figure 2. ).
Postmortem cultures of the aortic vegetation and abscess grew
C tropicalis.
View larger version (116K):
[in a new window]
Figure 3.
This article has been cited by other articles:
 |
|
 |
|
  P. Badiee, A. Alborzi, E. Shakiba, M. Ziyaeyan, and B. Pourabbas Molecular diagnosis of Aspergillus endocarditis after cardiac surgery J. Med. Microbiol., February 1, 2009; 58(2): 192 - 195. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. C. Pierrotti and L. M. Baddour Fungal Endocarditis, 1995-2000 Chest, July 1, 2002; 122(1): 302 - 310. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||