FUNGAL ENDOCARDITIS OF THE RIGHT SIDE HEART: A DIAGNOSTIC AND THERAPEUTIC CHALLENGE A CASE REPORT AND LITERATUREREVIEW

Infectiveendocarditisisdefined as an infection of one or more heart valves by bacteria, more rarely by intracellulargerms or yeasts. Involvement of the parietalendocardiumislesscommon. Infectiveendocarditisis rare but serious (1). Even rarerisfungalendocarditis of the rightsideheart. We report here the case of afemale 48-year-old patient withcrohnsdiseaseunder immunosuppressive therapyadmitted to intensive care for management of a febriledisorder of consciousness. Biological and radiological investigations revealedavegetation of the tricuspid valve and candida fungemia, indicating a diagnosis of fungalendocarditis of the right heart. The patient was put on fluconazole 800mg/daywith a good initial course, followed by a worsening of herclinical and biological condition in connectionwithpulmonaryempyema and a nosocomial infection withmulti-resistantacinetobacterbaumanii, whichcompromisedherprognosis. The patient died in multiple organfailure. Certain riskfactors, such as intravenousdrug use, immunodepression and intravenouscatheters, predispose to both right-heart and fungalendocarditis. The clinicalpresentationis not verydifferentfromthat of the leftheart, but specialmethods are needed to detectit. Treatmentisessentiallybased on antifungal agents and surgery.