Rapidly growing fungus ball on prosthetic valve: Candida albicans endocarditis

A 58-year-old woman presented with recent history of fever. She had history of prosthetic aortic and mitral valve implanted four years ago. Blood cultures were negative and transesophageal echocardiography (TEE) detected a large mass within the mitral prosthesis (Fig. 1a, Video 1). After seven days under antibiotherapy, repeated TEE revealed rapidly growing giant vegetation within the valve leaflets (Fig. 1b-d, Video 2, 3). Surgery was performed and rejection material showed fungus ball (Fig. 2a). Cultures and histopathological examinations (Fig. 2b, 3a, b) were positive for Candida albicans. Candida albicans is one of the most important fungal pathogens, caused prosthetic valve endocarditis in our case, with predisposing factors such as major operations, prosthetic material, total parenteral nutrition, broad-spectrum antibiotics, diabetes mellitus, and immunosuppression. Our patient had parenteral nutrition and broad-spectrum antibiotics. A combination of surgical resection and antifungal drug therapy is the Gold standard for treatment.