Key result
Nonsurgical management with port removal and sequential antifungals clears fungemia past ~590 days.
Why the study?
Fungal endocarditis caused by Exophiala dermatitidis is extremely rare, and optimal management remains unclear because most reported cases have received combined surgical and antifungal therapy.
Case Report (n=1)
Answers are grounded in this paper and cite their sources.
Nonsurgical management combining source control, sequential systemic antifungal therapy, and long-term azole suppression may be a feasible option for selected patients with Exophiala dermatitidis infective endocarditis who are inoperable.
Fungal endocarditis (FE) caused by Exophiala dermatitidis (E. dermatitidis) is extremely rare, and optimal management remains unclear because most reported cases have been treated with combined surgical and antifungal therapy. We describe a 76-year-old man with catheter-related bloodstream infection complicated by tricuspid valve FE due to E. dermatitidis. The patient had a history of repeated catheter-related infections and was considered a poor candidate for surgery because of his general condition. After prompt removal of the implanted central venous port, he received sequential antifungal therapy with micafungin, liposomal amphotericin B, voriconazole, and long-term itraconazole suppression. Blood cultures cleared, and serial transthoracic echocardiography showed no clinically significant progression of the tricuspid vegetation. At more than 590 days after diagnosis, he remains alive without recurrent fungemia while receiving oral itraconazole. This case suggests that nonsurgical management with source control, systemic antifungal therapy guided by clinical response and antifungal susceptibility information, and long-term azole suppression may be a feasible option for selected patients with E. dermatitidis FE when surgery is not possible.
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Sato et al. (2026) conducted a case report in Exophiala dermatitidis tricuspid valve fungal endocarditis following catheter-related bloodstream infection (n=1). Nonsurgical management with central venous port removal and sequential antifungal therapy (micafungin, liposomal amphotericin B, voriconazole, and long-term oral itraconazole suppression) was evaluated on Survival without recurrent fungemia and echocardiographic progression of tricuspid vegetation. Nonsurgical management with port removal, sequential antifungals, and itraconazole suppression resulted in survival without recurrent fungemia at >590 days in a 76-year-old man.
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