Year: 2014
Type: conference-abstract
Abstract: Background. Coccidioides, a dimorphic endemic fungus, primarily causes pulmonary disease but can disseminate to extrapulmonary sites. We describe a case of Coccidioides endocarditis, only the seventh ever reported. A 34-year-old Hispanic woman presented to Kern Medical Center with Miliary Coccidioidomycosis in 2004. She had a complicated relapsing course including an anaphylactoid reaction to amphotericin. In early 2013 she presented with dyspnea and was found to be in heart failure secondary to aortic insufficiency. Echocardiography did not demonstrate a vegetation. Medical management failed at least in part due to poor adherence. She then presented to another institution where valve replacement was attempted but aborted secondary to mediastinal fibrosis. She was then transferred to Sequoia Hospital. On transfer, she was hypoxic and again found to be in heart failure. Aortic regurgitation was confirmed on echocardiogram but no vegetation was detected. 4 sets of blood cultures were negative. Chest CT showed a 3.5 cm by 2.0 cm soft tissue mass in the anterior mediastinum with possible paratracheal and periaortic adenopathy. In the operating room, she was again found to have a fibrotic mass adherent to the aorta and base of the heart, but no gross purulence. A successful aortic valve replacement was accomplished. Pathology of the aortic valve revealed granulomatous inflammation and a PAS stain with endosporulating spherules diagnostic of Coccidioides spp. Culture of the native valve grew 1 colony identified by DNA probe as Coccidioides spp. Complement fixation titers were 1:8 with subsequent decrease to 1:2. The patient is doing well one year after surgery on Posaconazole liquid 400 mg every 12 hours. Conclusion. Coccidioides very rarely causes endocarditis, vegetations may not be detected by echocardiography, but a successful outcome may be achieved with combined surgical and medical management. Disclosures. R. H. Johnson, Astellas Pharma US: Speaker's Bureau, Speaker honorarium; Forest Phamaceuticals: Speaker's Bureau, Speaker honorarium; Pfizer Inc.: Investigator, Research support; Chevron: Grant Investigator, Grant recipient
Source: Open Forum Infectious Diseases
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W4242808227