Infective Endocarditis Followed by Fungal Prosthetic Valve Endocarditis and Mycotic Aneurysm of the Common Iliac Artery

(Department of Cardiovascular Surgery, Showa University School of Medicine, Tokyo, Japan)

Kazuto Maruta Tadashi Omoto Noboru Ishikawa
Masanori Hirota Masaya Ohi Masaomi Fukuzumi
Masahiro Ohno Tadanori Kawada Takeo Tedoriya
A 44-year-old man with a history of remittent fever for 6 months was given a diagnosis of infective endocarditis of the aortic valve related to a congenital ventricular septal defect (VSD), although no bacterial growth was obtained by blood culture. After one week of antibiotic treatment, aortic valve replacement (AVR) and patch closure of the VSD were performed after debridement of infected tissue and vegetations involving the aortic root, pulmonary and tricuspid valves, and myocardium surrounding the VSD. Antibiotic treatment was continued postoperatively, but elevation of C-reactive protein (CRP) persisted. Blood culture disclosed Candida albicans in the blood 3 months after AVR. Fungal prosthetic valve endocarditis (PVE) was suspected, therefore, aortic root replacement with a Free Style bioprosthesis and VSD re-closure were performed followed by continued systemic antifungal treatment. Five months after reoperation, the patient was readmitted with a high fever. A pseudoaneurysm of the left common iliac artery and complete obstruction of the external iliac artery were shown by contrast-enhanced computed tomography (CT). The aneurysm was resected without revascularization. This case presentation concludes that long-term whole body study with contrast-enhanced CT might be necessary even though complete eradication of the infected foci of the heart has been established.
@Jpn. J. Cardiovasc. Surg. 36: 188-192 (2007)