[Ischemia of the lower limbs as the initial manifestation of Candida albicans endocarditis in a parenteral drug addict].

BACKGROUND

Multiple infective complications have been described in injection drug users (IDUs). Infective endocarditis, most frequently caused by Gram positive bacteria, with classical features, is one of the most dangerous. In a few patients fungi are the cause (less than 5%), and these develop an unusual clinical picture.

METHODS

An IDUs patient was admitted in our Hospital for subacute arterial ischemia at the inferior limbs. A mass inside the abdominal aorta was detected by echography and arteriography, which was removed surgically a few hours later.

RESULTS

The pathologic evaluation of the surgical specimen revealed its fungal composition; the culture of this material was characteristic of Candida albicans. The clinical suspicion of aortic endocarditis, as the emboligenic source responsible of the inferior limbs ischemia, was confirmed with the performance of an echocardiography. A few hours after surgery the patient got worse; 24 hours later he died due to uncontrolled bleeding of the surgical suture in the aorta.

CONCLUSIONS

Fungal endocarditis should be thought in IDUs patients presenting inferior limbs ischemia. Due to the high mortality of this disease, as soon as the diagnosis is suspected, urgent medical and surgical therapy should be started.