Infection of implanted cardiac devices has a low rate of occurrence. Fungal infections of such devices represent an atypical phenomenon, associated with high mortality. Both medical and surgical therapies are recommended for a successful outcome. A 60-year-old woman with past medical history of heart failure with reduced ejection fraction, implantable cardioverter-defibrillator (ICD) placement, sarcoidosis and diabetes presented with fevers and atypical pleuritic chest pain. Transthoracic echocardiogram revealed a highly mobile 2.09 cm by 4.49 cm mass associated with the ICD wire. Blood cultures were positive for Candida albicans. The patient underwent sternotomy for removal. The vegetation was 4 cm by 2 cm by 2 cm in size, attached to the right ventricle without interference with the tricuspid valve. The patient was treated with micafungin for 2 weeks and then fluconazole for 6 weeks. In this case report, we describe the rare infection of an ICD lead with C. albicans, in the form of a fungal ball. This is the 18th reported case of Candida device-related endocarditis and the first reported in a woman. Prior case reports have occurred primarily in pacemaker rather than ICD leads. The vegetation size is also one of the largest that has been reported, measuring 4 cm at its greatest length. As Candida device-related endocarditis is so rare, and as fatality occurs in half of cases, clinical management can only be derived from sporadic case reports. Therefore, the course of this patient's disease care will be a useful adjunct to the current literature for determining treatment and prognosis in similar cases.
Este estudio pretende contribuir al conocimiento de la incidencia y factores de riesgo de la enfermedad trofoblástica gestacional en nuestro medio. El estudio en forma de caso control retrospectivo en el Hospital Arzobispo Loayza, incluyó 100 mujeres con enfermedad trofoblástica gestacional y como controles, 98 pacientes obstétricas normales atendidas en el hospital entre enero de 1984 y diciembre de 1992. La incidencia de mola hidatidiforme fue de 4,7 por 1000 partos, y la de coriocarcinoma, 0,149 por 1000 partos. La edad promedio fue 28,42 años. No se demostró que el estrato socioeconómico constituya un factor de riesgo. El grado de instrucción secundaria se asoció con un riesgo menor (OR=0,48, IC=0,233-0,98). No se demuestra un efecto protector o de riesgo de la multiparidad en la adquisición de enfermedad trofoblática gestacional. Las mujeres con esta patología tuvieron una edad de primera gestación significativamente menor (19,97 años), en comparación a sus controles obstétricos (21,22 años). El antecedente de embarazo molar previo se asoció con un incremento del riesgo, pero, sin alcanzar significación estadística (OR=6,51, p=0,101).
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