Qafisheh Qutaiba, Shubietah Abdalhakim, Aljunaidi Roaa, Sajdeya Omar, Baniowda Muath A, Giesige Cole, El-Hajj Stephanie C, Grande Robert
Department of Internal Medicine, University of Toledo, Toledo, USA.
Departement of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, USA.
J Cardiothorac Surg. 2025 Apr 18;20(1):213. doi: 10.1186/s13019-025-03377-y.
Histoplasma capsulatum infective endocarditis (IE) is rare and often fatal, especially in prosthetic valve patients, due to delayed diagnosis and limited therapeutic options. This case demonstrates the utility of AngioVac for managing large fungal vegetations, underscores the importance of considering fungal IE in culture-negative cases, and highlights the role of a multidisciplinary approach in high-risk patients. We report a 76-year-old female with a bioprosthetic aortic valve who presented with persistent culture-negative fever, splenic infarcts, and large vegetations on her prosthetic valve. Extensive diagnostic workup confirmed fungal endocarditis after AngioVac-assisted debulking revealed H. capsulatum on tissue cultures. Despite prompt initiation of antifungal therapy and multidisciplinary management, her course was complicated by recurrent embolic events, septic shock, and eventual death.
This case underscores the importance of considering fungal IE in culture-negative cases, especially in high-risk patients such as those with prosthetic valves. It also highlights the role of advanced diagnostic techniques and minimally invasive interventions like AngioVac in managing complex cases, despite their limitations.
荚膜组织胞浆菌感染性心内膜炎（IE）较为罕见且往往致命，尤其是在人工瓣膜患者中，原因是诊断延迟且治疗选择有限。本病例展示了AngioVac在处理大型真菌赘生物方面的效用，强调了在培养阴性病例中考虑真菌性IE的重要性，并突出了多学科方法在高危患者中的作用。我们报告一名76岁女性，她植入了生物人工主动脉瓣膜，出现持续培养阴性的发热、脾梗死以及人工瓣膜上的大型赘生物。广泛的诊断检查在AngioVac辅助减容术后组织培养发现荚膜组织胞浆菌后确诊为真菌性心内膜炎。尽管及时开始抗真菌治疗并进行多学科管理，但她的病程因反复栓塞事件、感染性休克及最终死亡而复杂化。
本病例强调了在培养阴性病例中考虑真菌性IE的重要性，特别是在高危患者如人工瓣膜患者中。它还突出了先进诊断技术和如AngioVac这样的微创干预措施在处理复杂病例中的作用，尽管它们存在局限性。
