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Histoplasma capsulatum prosthetic valve endocarditis treated with oral isavuconazole

Summary

A 76-year-old man developed a rare fungal infection on his artificial heart valve caused by Histoplasma capsulatum, a fungus found in soil and bird droppings. After surgery to replace the infected valve, he was treated with isavuconazole, an antifungal medication that proved highly effective and better tolerated than traditional treatments. After nine months of therapy, all signs of infection had resolved and his new valve was working properly.

Background

Histoplasma capsulatum is the most common cause of systemic fungal infections in the United States, particularly in older adults and immunosuppressed individuals. Mycotic endocarditis is uncommon, and histoplasmosis endocarditis is exceedingly rare, with limited updated guidelines on antifungal therapy.

Objective

To present a case of bioprosthetic aortic valve Histoplasma endocarditis treated with surgical intervention and isavuconazole therapy. The authors sought to demonstrate the efficacy of isavuconazole as an alternative to traditional antifungals due to tolerability concerns.

Results

After nine months of isavuconazole therapy, the patient remained asymptomatic with normalization of C-reactive protein, negative urine antigen, and reduced complement fixation titers from 1:512 to 1:32. Echocardiography confirmed stability of the new prosthetic valve without complications from antifungal treatment.

Conclusion

Combined surgical and antifungal therapy with isavuconazole successfully treated histoplasma endocarditis with favorable outcomes. This case adds to limited literature supporting isavuconazole as a viable alternative therapy for disseminated histoplasmosis endocarditis, particularly for patients with concerns about traditional antifungal tolerability.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 40893459, DOI: 10.1016/j.mmcr.2025.100723
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