Candida endocarditis is rare but has high morbidity and mortality.

Early diagnosis and comprehensive treatment strategy improve prognosis.

Embolic complications may be the first and only indicators.

Misidentification of species can occur and molecular methods are the most sensitive.

Treatment must be tailored by species identification and antifungal susceptibility.

Fungal endocarditis is a rare but serious form of infective endocarditis associated with high morbidity and mortality. Among fungal pathogens, Candida species are the most frequently isolated and commonly found in individuals with predisposing factors, such as prosthetic heart valves.

The clinical presentation of endocarditis is highly variable and nonspecific, often including symptoms and signs of embolization. In this paper, we present a case of fungal prosthetic valve endocarditis in which the initial presentation was an acute ischemic stroke. The initial misidentification of Candida famata was attributed to limitations in the presumptive methodology used through selective chromogenic culture identification. However, the surgical specimen underwent mass spectrometry, leading to the correct identification of Candida guilliermondii instead of Candida famata. Furthermore, we conducted a non-systematic narrative review of the literature on Candida endocarditis.

Our findings underscore the importance of considering fungal endocarditis in the differential diagnosis of patients with possible extracardiac complications, particularly those with a history of heart valve replacement. Early diagnosis and a comprehensive treatment strategy tailored by species identification and antifungal susceptibility testing are crucial in improving patient outcomes.

candida species

Candidemia

Embolic stroke

Endocarditis

Fungi

European Society of Cardiology

matrix-assisted laser desorption⁄ionisation time-of-flight

magnetic resonance angiography

magnetic resonance imaging

partial anterior circulation infarct

positron emission tomography

prosthetic valve endocarditis

single-photon emission computed tomography

transthoracic echocardiogram

transesophageal echocardiogram

© 2023 The Author(s). Published by Elsevier Inc.