Introduction: Embolic events are known complications of infective endocarditis but fungal secondary mycotic aneurysms rarely result. C. parapsilosis endocarditis with intra-cerebral embolism and secondary mycotic aneurysm formation was never described before. Case report: A 37 year-old i.v. drug abuser was first hospitalized on October 2004 with acute thromboembolic stroke and C. parapsilosis candidemia. Exhaustive research for a primary focus was negatives. The fungigram showed an intermediary sensitivity to fluconazole for the isolated strain and a treatment with voriconazole was started. The patient had favourable evolution and the treatment was discontinued after 3 months. Six weeks after the treatment was stopped he was hospitalized due to an acute hemiparesia. The MRI showed a cerebral artery occlusion and an intra-arterial thrombolysis was performed. C. parapsilosis yielded from the blood cultures with the same resistance pattern to the previous strain. Voriconazole was restarted. Due to an important aortic insufficiency with floating vegetation the aortic valve was replaced by a porcine xenograft. The neurological symptoms had an slight improvement. The new MRI done showed the cerebral media artery occluded with a fusiform aneurysm. Serial The stability of the lesion in the following months was documented by MRI done for control. After 9 months of voriconazole treatment the patient did not experienced any recurrence. Discussion: Acute stroke is a feared complication of infective endocarditis. Up to 50% of patients with fungal endocarditis show arterial thromboembolic events and nearly 20% of them are intra-cranial. Interestingly, despite endocarditis is the major cause of intra-cranial bacterial aneurysms, secondary intracranial fungal aneurysm are very rare. A limited number of reports describe fungal mycotic aneurysm, but most are due to Aspergillus sp. To our knowledge there are only 2 reports of candida intra-cranial aneurysms and none caused by Candida non-albicans species. Given the limited number of experience, therapeutic guidelines and experience with invasive therapeutic interventions are lacking.
Full conference title:
16th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 16th (2006)