PT  - JOURNAL ARTICLE
AU  - Lauren Card
AU  - Denene Lofland
TI  - Candidal Endocarditis Presenting with Bilateral Lower Limb Ischemia
AID  - 10.29074/ascls.25.3.130
DP  - 2012 Jul 01
TA  - American Society for Clinical Laboratory Science
PG  - 130--134
VI  - 25
IP  - 3
4099  - http://hwmaint.clsjournal.ascls.org/content/25/3/130.short
4100  - http://hwmaint.clsjournal.ascls.org/content/25/3/130.full
SO  - Clin Lab Sci2012 Jul 01; 25
AB  - The incidence of fungal endocarditis is increasing. While the pathogenic mechanisms are not fully understood, infection is associated with underlying heart disease and is most often attributable to Candida species. Candidal endocarditis complications include heart damage, inflammation, and emboli with resulting ischemia and tissue death. Candidal endocarditis is difficult to diagnose as blood cultures are often negative. Treatment includes surgical intervention and antifungal therapy. This case study describes a 41-year-old female complaining of acute onset of pain with numbness and tingling in both lower extremities. Prior history was significant for mycotic valve aneurysm and replacement secondary to culture-negative endocarditis. Evidence of limb-threatening ischemia led to a bilateral thrombectomy. During the thrombectomy white debris, later identified as Candida albicans, was encountered. A transesophogeal echocardiogram revealed a pedunculated mass which was determined to be the source of infection. The patient was placed on micafungin and voriconazole and discharged with a diagnosis of C. albicans fungal infection with descending aorta fungal mass. This case study illustrates an unusual presentation of candidal endocarditis with discussion of disease epidemiology, pathogenesis, diagnosis, and treatment.ABBREVIATIONS: Spp. - species, KOH - Potassium Hydroxide, PNA FISH - peptide nucleic acid fluorescence in situ hybridization, DVT - Deep Vein Thrombosis, WBC - White Blood Cell