Abstract Introduction Candida species are commonly a part of the normal human microbiota, inhabiting non-sterile tissues such as the respiratory, gastrointestinal, urinary, and genital tracts, as well as the skin, fingernails, and oral cavity. Candida species represent the leading etiological agents of fungal endocarditis, with reported mortality rates ranging between 50% and 80%. Candida lusitaniae is responsible for less than 5% of all invasive Candida infections and predominantly occurs in immunocompromised individuals. Here, we present the case of a rare Candida lusitaniae endocarditis in a patient with a history of JAK-2 mutation and severe aortic stenosis status post transcatheter aortic valve replacement (TAVR), complete heart block and with permanent pacemaker placement. Case Presentation 80 year old female with a past medical history significant of type 2 diabetes, JAK-2 gene mutation with chronic leukocytosis, status post TAVR, recurrent urinary tract infections presents to the emergency department for encephalopathy. The patient was found to have septic nephrolithiasis requiring stent placement which required admission to the intensive care unit. Initially, the patient was treated with linezolid and piperacillin-tazobactam. She was found to have Candida lusitaniae candidemia in the setting of permanent pacemaker wire vegetation seen on transesophageal echocardiogram. Initially, the patient was treated with micafungin. However, blood cultures remained positive for Candida lusitaniae. Thus, fluconazole was added and blood cultures subsequently cleared. Removal of the infected pacemaker for source control was recommended, but the patient’s family declined. The patient was then transferred to the general floors where she developed sepsis from aspiration pneumonia. She continued to deteriorate and her family decided to transition her to comfort care. Discussion Candida lusitaniae is a rare type of invasive endocarditis. Antifungal choice along with source control is crucial for recovery. Echinocandins are the most common choice due to some resistance against azoles and flucytosine. Emerging evidence shows that multidrug resistance to C. lusitaniae is prone to occur with azoles and amphotericin B. The antifungal action of echinocandins is based on its ability to target 1,3-beta-D-glucan synthesis thus leading to cellular lysis. Resistance to echinocandins is rare but could occur through the overexpression of efflux pumps in the fungal cell wall. In one study, they looked at infection risks in patients with JAK inhibition. Patients with JAK-STAT mutation can lead to recurrent candida infections. Due to lack of studies, it would be interesting in the future to evaluate the risk of candida infections in patients with hematological disorders. This abstract is funded by: none
Houry et al. (Fri,) studied this question.