Conclusion
C. parapsilosis is a rare cause of fungal endocarditis, commonly
associated with IVDU. C. parapsilosis endocarditis has a
predilection for the aortic valve and is more common in patients with
bioprosthetic valves. It has a high mortality of about 40%. Our case
presents a patient with risk factors for invasive fungal infection (IVDU
and splenomegaly) who developed C. parapsilosis endocarditis,
first of her native aortic valve and subsequently of her bioprosthetic
valve. One of the challenging aspects of this case was the recurrent
presentations C. parapsilosis candidemia and the persistent
candidemia despite appropriate use of recommended first-line antifungal
therapy, necessitating trials of multiple first-line therapies. The
organism’s ability to form biofilms is suspected to be the significant
contributing factor to the persistent and relapsing nature of invasive
infections caused by this organism.
C. parapsilosis endocarditis has a high mortality rate that
approaches 40%. As the aortic valve is most commonly affected, there is
often involvement of many organ systems due to septic embolization. High
clinical suspicion and a multidisciplinary approach is needed in these
cases to reduce morbidity and prevent mortality.