Candidemia Complicated by Mycotic Thrombus of the Femoral Artery in a Patient With Left Ventricular Assist Device

Background Ventricular assist devices (VADs) are increasingly used as a bridge to transplantation or as destination therapy in heart failure patients. Fungal bloodstream infections, though less common than bacterial infections in VAD recipients, carry the highest mortality. Arterial involvement, including mycotic thrombus formation, is exceptionally rare and poses diagnostic and therapeutic challenges. We report the first documented case of candidemia complicated by femoral arterial mycotic thrombus in an LVAD recipient. Case Presentation A 50‐year‐old man developed Candida albicans fungemia four months after undergoing LVAD implantation for severe dilated cardiomyopathy. Intravenous caspofungin was initiated due to potential azole–warfarin interactions. Blood cultures rapidly became negative, and multimodal imaging revealed no LVAD or endovascular involvement. On day 37 of ongoing antifungal therapy, ultrasound identified a subocclusive femoral artery thrombus at a prior cannulation site. Surgical thrombectomy confirmed C. albicans within the clot. Antifungal therapy continued, and the patient underwent successful emergency heart transplantation 15 days later. Discussion Invasive fungal vascular infections may occur despite negative blood cultures and absence of detectable device involvement. Prior arterial trauma likely predisposed to localized fungal colonization. Management required careful risk assessment, prompt surgical intervention, and individualized antifungal therapy. Multidisciplinary collaboration among infectious disease specialists, radiologists, cardiologists, and cardiac surgeons was critical. Definitive source control through device explantation and transplantation was essential for curative intent. Device removal should be considered on a case‐by‐case basis, even when imaging shows no infectious foci, as prognosis without it may be poor. Fungal infection does not necessarily contraindicate transplantation, and early recognition combined with tailored therapy can optimize outcomes. Conclusions Arterial Candida thrombus in LVAD recipients is rare but life‐threatening. High clinical suspicion, multimodal diagnostics, prompt surgical management, and individualized antifungal therapy are essential. Further studies are needed to define optimal antifungal strategies, surveillance, and transplant considerations for these high‐risk infections.