Ino Ayaka, Omori Taku, Inoue Ryosai, Toyoshima Hirokazu, Tone Katsuyuki, Fujimoto Naoki, Seko Tetsuya, Tokui Toshiya, Kasai Atsunobu, Dohi Kaoru
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan; Department of Cardiology, Ise Red Cross Hospital, Ise, Japan.
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
JACC Case Rep. 2025 Sep 3;30(26):104903. doi: 10.1016/j.jaccas.2025.104903.
Surgical treatment for infective endocarditis (IE) with severe thrombocytopenia is considered high risk and is often avoided.
A 67-year-old man with a history of 3 open-heart surgeries presented with fever and severe thrombocytopenia accompanied by a bleeding tendency. Blood cultures and transthoracic echocardiography confirmed IE of the aortic bioprosthetic valve caused by Candida parapsilosis. Despite appropriate antifungal medical therapy, blood cultures remained persistently positive, severe thrombocytopenia persisted, and the vegetation continued to enlarge, resulting in medially refractory IE. Surgical intervention was deemed essential, and the patient underwent a fourth open-heart surgery. Shortly after the procedure, blood cultures turned negative, and platelet counts improved dramatically. The patient was discharged home.
Severe thrombocytopenia in this case was likely caused by the fungal infection and vegetation formation.
TAKE-HOME MESSAGE: Surgical treatment for medically refractory fungal IE can aid in infection control and result in significant improvement in platelet count.
