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Histoplasma capsulatum prosthetic valve endocarditis treated with oral isavuconazole

Summary

A 76-year-old man developed a rare fungal infection of his artificial heart valve caused by Histoplasma capsulatum. After surgically replacing the infected valve, he was treated with isavuconazole, an antifungal medication taken by mouth. Unlike traditional antifungal treatments, isavuconazole was better tolerated and easier to take. The patient successfully recovered after nine months of treatment with no complications.

Background

Histoplasma capsulatum is the most common cause of systemic fungal infections in the United States. Mycotic endocarditis is rare, and histoplasmosis endocarditis is exceedingly uncommon with limited data on treatment outcomes using newer antifungals.

Objective

To present a case of bioprosthetic aortic valve Histoplasma endocarditis and demonstrate successful treatment with combined surgical intervention and isavuconazole antifungal therapy.

Results

Histoplasma capsulatum was confirmed through positive urine antigen, complement fixation tests, fungal blood cultures, and PCR. The patient underwent aortic valve replacement and was treated with isavuconazole for 12 months, achieving sustained clinical response with normalization of CRP, negative urine antigen, and reduced complement fixation titers.

Conclusion

Combined surgical and antifungal treatment with isavuconazole resulted in successful outcome without complications. This case adds to limited literature supporting isavuconazole as an alternative therapy for histoplasmosis endocarditis when traditional agents are poorly tolerated.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 40893459, DOI: 10.1016/j.mmcr.2025.100723
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