Key result
Real-time 3D-TEE accurately diagnoses fungal prosthetic valve endocarditis complicating STEMI.
Why the study?
Acute coronary syndrome is a rare, high-mortality complication of infective endocarditis typically caused by bacterial autologous valve infection, and documentation of fungal prosthetic valve endocarditis causing embolic STEMI is limited.
Case Report (n=1)
Fungal prosthetic valve endocarditis can present as a rare complication of STEMI, and real-time 3D-TEE is instrumental in diagnosing and accurately assessing the vegetation.
Raises awareness of fungal PVE complicating STEMI; leaves open 3D-TEE role pending larger studies.
Acute coronary syndrome (ACS) is a rare complication of infective endocarditis (IE) and is associated with high mortality. Typically, coronary artery occlusion is a complication of bacterial autologous valve IE. We present the case of a 74-year-old woman with a history of aortic valve replacement for aortic stenosis who was receiving immunosuppressive therapy for rheumatoid arthritis. Upon admission, she was diagnosed with ST-elevation myocardial infarction (STEMI), and coronary angiography (CAG) revealed complete occlusion in the terminal branches of the left circumflex coronary artery (LCX #12 and #14). On day 3 of admission, three-dimensional transesophageal echocardiography (3D-TEE) was performed, and vegetation was detected, leading to IE diagnosis.The patient underwent prosthetic valve replacement on day 4. Subsequent blood cultures grew Candida albicans, and histopathological examination using Grocott staining confirmed the presence of Grocott-positive fungi within the vegetation, leading to a definitive diagnosis of prosthetic valve endocarditis (PVE) caused by Candida albicans; this management resulted in favorable outcomes. The present case suggests that fungal PVE can also complicate STEMI, and real-time 3D-TEE was instrumental in diagnosing and accurately assessing the vegetation in this condition.
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Tanaka et al. (2025) conducted a case report in Fungal Prosthetic Valve Endocarditis complicated by STEMI (n=1). Prosthetic valve replacement and 3D-TEE diagnosis was evaluated on Clinical outcome after prosthetic valve replacement. Fungal prosthetic valve endocarditis caused by Candida albicans can complicate STEMI, and real-time 3D-TEE was instrumental in diagnosing and accurately assessing the vegetation.
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