A chronic hemodialysis patient with isolated pulmonary valve infective endocarditis caused by non-albicans Candida: a rare case and literature review

BMC Nephrology

Case Report

Myo-Ming Huang¹  Yi-Chou Hou²  Dong-Feng Yeih³  Kuo-Cheng Lu⁴  Chih-Hao Chang⁵ 

[1] Department of Internal Medicine, Cardinal Tien Hospital An-Kang branch, School of Medicine, Fu-Jen Catholic University, No. 15, Chezi Road., Hsin-Tien District, 23155, New Taipei City, Taiwan, Republic of China;Department of Internal Medicine, Cardinal Tien Hospital An-Kang branch, School of Medicine, Fu-Jen Catholic University, No. 15, Chezi Road., Hsin-Tien District, 23155, New Taipei City, Taiwan, Republic of China;Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China;Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, 362 Chung-Cheng Road, Hsin-Tien District, 23148, New Taipei City, Taiwan, Republic of China;Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, 362 Chung-Cheng Road, Hsin-Tien District, 23148, New Taipei City, Taiwan, Republic of China;Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China;Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China;Department of Thoracic Medicine, Chang-Gang Memorial Hospital, Linkou Branch, No.5, Fuxing St., Guishan Dist, 33305, Taoyuan City, Taiwan, Republic of China;

关键词: Candida guilliermondii;    Pulmonary valve;    Infective endocarditis;   

DOI  :  10.1186/s12882-017-0706-3

 received in 2016-02-03, accepted in 2017-08-24,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIsolated pulmonary valve infective endocarditis caused by Candida is rare in chronic hemodialysis patients. The 2009 Infectious Diseases Society of America guidelines suggest the combined use of surgery and antibiotics to treat candidiasis; however, successful nonsurgical treatment of Candida endocarditis has been reported.Case presentationA 63-year-old woman with end-stage kidney disease was admitted to our hospital after experiencing disorientation for 5 days. The patient was permanently bedridden because of depression, and denied active intravenous drug use. She received maintenance hemodialysis through a tunneled-cuffed catheter. An initial blood culture grew Candida guilliermondii without other bacteria. Subsequent blood cultures and tip culture of tunneled-cuffed catheter also grew C. guilliermondii, even after caspofungin replaced fluconazole. A 1.2-cm mobile mass was observed on the pulmonary valve. Surgical intervention was suggested, but the family of the patient declined because of her multiple comorbidities. The patient was discharged with a prescription of fluconazole, but she died soon after.ConclusionOur patient is the first case with isolated pulmonary valve endocarditis caused by C. guilliermondii in patients with uremia. Hematologic disorders, in addition to long-term central venous catheter use, prolonged antibiotic intravenous injection, and congenital cardiac anomaly, predispose to the condition. The diagnosis “isolated” pulmonary IE is difficult, and combing surgery with antifungal antibiotics is the appropriate therapeutic management for Candida related pulmonary IE.

【 授权许可】

CC BY   
© The Author(s). 2017