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Favourable outcome of Fusarium prosthetic valve endocarditis in a patient with an Ebstein anomaly

Summary

A 26-year-old woman with a congenital heart condition (Ebstein anomaly) received a replacement heart valve. Six months later, a rare fungal infection caused by Fusarium developed on the new valve, leading to lung complications. Through a combination of surgery to remove the infected valve and antifungal medications, particularly voriconazole, the patient recovered successfully. This case demonstrates that even life-threatening fungal heart infections can be treated with proper surgical intervention and targeted medication.

Background

Fungal endocarditis is rare and challenging to diagnose and treat, accounting for 1-2% of all endocarditis cases and up to 4% of prosthetic valve cases. Fusarium species are uncommon causes with high mortality rates reaching 80%. This case represents the first confirmed Fusarium endocarditis in a patient with Ebstein’s anomaly.

Objective

To describe a case of Fusarium solani endocarditis in a 26-year-old woman with Ebstein’s anomaly and a bioprosthetic tricuspid valve, highlighting the importance of surgical intervention and proper diagnostic testing for fungal infections.

Results

The patient had large vegetations on her tricuspic bioprosthesis with bilateral lung abscesses. Fusarium solani was identified through culture and 18s PCR sequencing of the excised valve. Following surgical removal of the infected prosthesis and antifungal therapy with voriconazole monotherapy for 12 weeks, the patient achieved complete clinical resolution with normal transoesophageal echocardiogram.

Conclusion

Successful treatment of this rare Fusarium endocarditis required surgical source control, discontinuation of corticosteroids, and targeted antifungal therapy. Submission of infected material for histology, culture, and molecular testing is critical for diagnosis. This case emphasizes that favorable outcomes are possible with early intervention and appropriate management despite the typically poor prognosis of fungal endocarditis.
  • Published in:South African Journal of Infectious Diseases,
  • Study Type:Case Report,
  • Source: PMID: 40060086, DOI: 10.4102/sajid.v40i1.699
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