Devathi Sudhakar, Curry Bryan, Doshi Saumil
BMC Infect Dis. 2014 Oct 30;14:557. doi: 10.1186/s12879-014-0557-5.
Pulmonary valve endocarditis without the involvement of other valves represents 1.5-2% of all cases of infective endocarditis. Isolated pulmonary valve endocarditis caused by Candida is extremely rare with only one reported case in the literature and none reported in the United States. Guidelines for management of Candida endocarditis recommend a combination of medical and surgical therapy.
A 61-year-old homeless male presented with fever, cough and shortness of breath. He was urgently intubated for hypoxia. He was initially diagnosed with pneumonia but did not improve with empiric antibacterial therapy. Candida species were isolated from bronchoalveolar lavage fluid and the patient eventually developed persistent C. albicans bloodstream infection. On further workup he was found to have infective endocarditis with a large vegetation across the pulmonary valve. No other valves were involved. He was treated with intravenous antifungal therapy for eight weeks. Valvular surgery was not performed. Follow up echocardiography after completion of therapy did not show any vegetations and the patient clinically improved.
This is the second reported case of isolated pulmonary valve endocarditis caused by Candida and the first to be successfully managed with antifungal therapy alone. Pulmonary valve endocarditis should be considered in cases of pneumonia with Candida and persistent fungemia. While surgery should be considered in all cases of Candida endocarditis, cure may be achieved with antifungal therapy alone.
单纯累及肺动脉瓣的感染性心内膜炎占所有感染性心内膜炎病例的1.5% - 2%。念珠菌引起的孤立性肺动脉瓣心内膜炎极为罕见，文献中仅报道过1例，美国尚无相关报道。念珠菌性心内膜炎的治疗指南推荐采用药物和手术联合治疗。
一名61岁的无家可归男性因发热、咳嗽和呼吸急促就诊。因缺氧紧急插管。最初诊断为肺炎，但经验性抗菌治疗后病情未改善。支气管肺泡灌洗液中分离出念珠菌属，患者最终发展为持续性白色念珠菌血流感染。进一步检查发现其患有感染性心内膜炎，肺动脉瓣上有一个大的赘生物。未累及其他瓣膜。给予静脉抗真菌治疗8周。未进行瓣膜手术。治疗结束后的超声心动图随访未显示任何赘生物，患者临床症状改善。
这是文献报道的第二例由念珠菌引起的孤立性肺动脉瓣心内膜炎病例，也是首例仅通过抗真菌治疗成功治愈的病例。对于伴有念珠菌感染和持续性真菌血症的肺炎患者，应考虑肺动脉瓣心内膜炎。虽然所有念珠菌性心内膜炎病例均应考虑手术治疗，但仅通过抗真菌治疗也可能治愈。
