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Endocarditis caused by Scopulariopsis brevicaulis with disseminated emboli and multiple vascular aneurysms: A case report and literature review

Summary

A 61-year-old man with a prosthetic aortic valve developed a rare fungal infection caused by Scopulariopsis brevicaulis, a mold usually associated with nail infections. The infection spread throughout his body, causing multiple strokes and aneurysms that required emergency surgery and treatment with various antifungal medications. This case highlights the serious complications that can occur when this typically harmless fungus invades the heart and demonstrates the challenges doctors face in treating such rare infections, as the fungus was resistant to many common antifungal drugs.

Background

Scopulariopsis brevicaulis is a saprophytic fungus commonly associated with onychomycosis that rarely causes deep-tissue infections in immunocompromised patients. Its role in fungal endocarditis is exceptionally rare, making cases of this infection particularly notable and worthy of clinical attention.

Objective

To review the antifungal susceptibility of S. brevicaulis and management strategies for endocarditis and other invasive infections caused by this organism. The review emphasizes diagnostic challenges and clinical implications of disseminated infection while summarizing published cases and current treatment approaches.

Results

Seven cases of S. brevicaulis prosthetic valve endocarditis were identified, characterized by slow disease onset, large vegetations, and common thrombotic and embolic complications. The patient’s isolate showed multi-drug resistance with lowest MIC for Isavuconazole at 0.75 mg/L, while olorofim demonstrated promising in vitro activity with MIC range of ≤0.008–0.5 mg/L.

Conclusion

S. brevicaulis presents significant treatment challenges due to its rare nature and frequent multi-drug resistance, requiring a practical approach combining medical and surgical strategies customized to individual cases. Determining minimum inhibitory concentrations is essential for guiding treatment decisions, and olorofim shows remarkable potential as a novel therapeutic option for this difficult-to-treat mold.
  • Published in:IDCases,
  • Study Type:Case Report and Literature Review,
  • Source: PMID: 41017841, DOI: 10.1016/j.idcr.2025.e02366
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