What is the clinical evidence from this study?

Study design: Case Report. Population: Fungal Prosthetic Valve Endocarditis complicated by STEMI (n=1). Intervention: Prosthetic valve replacement and 3D-TEE diagnosis. Primary outcome: Clinical outcome after prosthetic valve replacement.

January 30, 2025Open Access

A Case of Fungal Prosthetic Valve Endocarditis Complicated by Embolic ST-Elevated Myocardial Infarction

Key Result

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.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

1 female patient (age 79) with a history of aortic valve replacement for aortic stenosis and ongoing immunosuppressive therapy for rheumatoid arthritis, presenting with ST-elevation myocardial infarction (STEMI) complicated by Candida albicans prosthetic valve endocarditis.

Intervention

Antifungal therapy combined with prosthetic aortic valve replacement.

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.

Abstract

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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