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Caspofungin therapy in prosthetic valve endocarditis and candidemia due to itraconazole-resistant Candida glabrata (Nakaseomyces glabratus): A case report

Summary

A 13-year-old boy developed a serious fungal infection of his heart valve after receiving an artificial valve replacement. The initial antibiotic (itraconazole) did not work because the fungus became resistant, likely by forming a protective biofilm. After identifying the resistant fungus through specialized testing, doctors switched to a different medication called caspofungin. The patient fully recovered with this new treatment and remained healthy during follow-up, showing that combination of precise identification and targeted treatment can overcome antibiotic resistance.

Background

Candidemia is a prevalent nosocomial bloodstream infection with high mortality rates up to 40%. Candida glabrata (Nakaseomyces glabratus) is increasingly recognized as a pathogen causing severe fungemia with ability to disseminate and target heart valves. Non-albicans Candida species pose challenges due to their unfamiliar pathogenicity and limited diagnostic options.

Objective

To present a case of prosthetic valve endocarditis and candidemia caused by itraconazole-resistant Candida glabrata in a 13-year-old patient and demonstrate the effectiveness of caspofungin treatment combined with antifungal susceptibility testing on both planktonic and biofilm forms.

Results

The isolate was identified as itraconazole-resistant C. glabrata (MIC=8 µg/mL) but susceptible to amphotericin B and caspofungin. After 4 weeks of failed itraconazole therapy, treatment was switched to caspofungin (3 mg/kg/day) for 5 weeks, resulting in complete clinical remission with no relapse during 6-month follow-up.

Conclusion

This case underscores the importance of molecular diagnostics combined with biofilm-specific antifungal susceptibility testing in managing complex Candida infections. Caspofungin monotherapy proved effective for prosthetic valve endocarditis caused by itraconazole-resistant C. glabrata without surgical intervention, suggesting echinocandins may be valuable alternatives even when surgery cannot be performed.
  • Published in:Current Medical Mycology,
  • Study Type:Case Report,
  • Source: PMID: 41122117, DOI: 10.22034/cmm.2025.345248.1615
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