Not “Much Room” in the Heart: A Rare Case of a Massive Intracardiac Candida Mass
Introduction. Coupled with the increasing use of indwelling vascular catheters and prosthetic cardiac valves is an uptrend in sepsis secondary to fungemia. An insidious onset often shrouds the initial diagnosis, contributing to poor outcomes. Candida infective endocarditis (CIE) is a feared complica...
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| Format: | Article |
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Wiley
2021-01-01
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| Series: | Case Reports in Infectious Diseases |
| Online Access: | http://dx.doi.org/10.1155/2021/9216825 |
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| author | Ali Haider Jafry Sardar Hassan Ijaz Murtaza Mazhar Areeba Shahnawaz Ali Yousif |
| author_facet | Ali Haider Jafry Sardar Hassan Ijaz Murtaza Mazhar Areeba Shahnawaz Ali Yousif |
| author_sort | Ali Haider Jafry |
| collection | DOAJ |
| description | Introduction. Coupled with the increasing use of indwelling vascular catheters and prosthetic cardiac valves is an uptrend in sepsis secondary to fungemia. An insidious onset often shrouds the initial diagnosis, contributing to poor outcomes. Candida infective endocarditis (CIE) is a feared complication of candidemia, associated with high mortality rates. It requires prolonged hospital stays for medical and, often, surgical management. We report a case of a massive intracardiac Candida mass in an adult with native valve CIE. Case. A 51-year-old male on chronic total parenteral nutrition (TPN) because of bowel resection presented with fevers, night sweats, and unintentional weight loss. He was febrile and tachycardiac on admission, with a benign physical examination. Laboratory workup showed elevated inflammatory markers and an acute kidney injury. Extended blood cultures showed growth of Candida glabrata (C. glabrata) and Candida dubliniensis (C. dubliniensis). Transthoracic (TTE) and transesophageal echocardiography revealed a large mobile right atrial mass (4 cm × 6 cm × 2.5 cm), extending to the right ventricular outflow tract. Since he was a poor surgical candidate, management with micafungin was initiated and continued for 8 weeks. He responded well to the regimen with resolution of the fungal mass on follow-up TTE 3 months later. In anticipation of the future need for TPN, he continues on lifelong suppressive oral fluconazole. Conclusion. CIE may be an insidious complication of indwelling central venous catheters, necessitating a high index of suspicion. Conservative management, with antifungal therapy, can yield favorable outcomes in poor surgical candidates. |
| format | Article |
| id | doaj-art-ab860ded97f946de8560b68eeb6c2a9a |
| institution | Kabale University |
| issn | 2090-6625 2090-6633 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Infectious Diseases |
| spelling | doaj-art-ab860ded97f946de8560b68eeb6c2a9a2025-02-03T07:23:59ZengWileyCase Reports in Infectious Diseases2090-66252090-66332021-01-01202110.1155/2021/92168259216825Not “Much Room” in the Heart: A Rare Case of a Massive Intracardiac Candida MassAli Haider Jafry0Sardar Hassan Ijaz1Murtaza Mazhar2Areeba Shahnawaz3Ali Yousif4800 Stanton L. Young Blvd, AAT 6300, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City 73105, OK, USADepartment of Cardiovascular Disease, Lahey Medical Center, 41 Mall Road, Burlington 01805, MA, USADepartment of Cardiovascular Disease, University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston 77555, TX, USAFaisalabad Medical University, Sargodha Road, Faisalabad 38000, Punjab, PakistanBaylor Scott and White the Heart Hospital Arrhythmia Management, 1100 Allied Dr, Plano 75093, TX, USAIntroduction. Coupled with the increasing use of indwelling vascular catheters and prosthetic cardiac valves is an uptrend in sepsis secondary to fungemia. An insidious onset often shrouds the initial diagnosis, contributing to poor outcomes. Candida infective endocarditis (CIE) is a feared complication of candidemia, associated with high mortality rates. It requires prolonged hospital stays for medical and, often, surgical management. We report a case of a massive intracardiac Candida mass in an adult with native valve CIE. Case. A 51-year-old male on chronic total parenteral nutrition (TPN) because of bowel resection presented with fevers, night sweats, and unintentional weight loss. He was febrile and tachycardiac on admission, with a benign physical examination. Laboratory workup showed elevated inflammatory markers and an acute kidney injury. Extended blood cultures showed growth of Candida glabrata (C. glabrata) and Candida dubliniensis (C. dubliniensis). Transthoracic (TTE) and transesophageal echocardiography revealed a large mobile right atrial mass (4 cm × 6 cm × 2.5 cm), extending to the right ventricular outflow tract. Since he was a poor surgical candidate, management with micafungin was initiated and continued for 8 weeks. He responded well to the regimen with resolution of the fungal mass on follow-up TTE 3 months later. In anticipation of the future need for TPN, he continues on lifelong suppressive oral fluconazole. Conclusion. CIE may be an insidious complication of indwelling central venous catheters, necessitating a high index of suspicion. Conservative management, with antifungal therapy, can yield favorable outcomes in poor surgical candidates.http://dx.doi.org/10.1155/2021/9216825 |
| spellingShingle | Ali Haider Jafry Sardar Hassan Ijaz Murtaza Mazhar Areeba Shahnawaz Ali Yousif Not “Much Room” in the Heart: A Rare Case of a Massive Intracardiac Candida Mass Case Reports in Infectious Diseases |
| title | Not “Much Room” in the Heart: A Rare Case of a Massive Intracardiac Candida Mass |
| title_full | Not “Much Room” in the Heart: A Rare Case of a Massive Intracardiac Candida Mass |
| title_fullStr | Not “Much Room” in the Heart: A Rare Case of a Massive Intracardiac Candida Mass |
| title_full_unstemmed | Not “Much Room” in the Heart: A Rare Case of a Massive Intracardiac Candida Mass |
| title_short | Not “Much Room” in the Heart: A Rare Case of a Massive Intracardiac Candida Mass |
| title_sort | not much room in the heart a rare case of a massive intracardiac candida mass |
| url | http://dx.doi.org/10.1155/2021/9216825 |
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