Cryptococcal endocarditis of native valves without immunodeficiency or drug abuse: a case report

Abstract

Cryptococcal endocarditis has rarely been reported. Most patients with this condition are associated with risk factors, such as structural heart disease/valve replacement, immunodeficiency/immunosuppression or drug abuse. We report a case of cryptococcal endocarditis of the native valves without any risk factors. A 50-year-old Chinese man was admitted to hospital with fever for 1 month without any underlying heart disease, immunodeficiency, or drug use. He was diagnosed as having Cryptococcus neoformans infective endocarditis and was discharged after valve replacement surgery and long-term antifungal therapy.

Cryptococcal endocarditis of native valve in a patient with systemic lupus erythematosus

“…C. neoformans is typically known to cause serious central nervous system that infections, most commonly causing meningitis with lung and skin infections [ 4 ]. In one study, conditions associated with Cryptococcal infection in non-HIV individuals included immunosuppressive drug treatment (41%), SLE (16%), malignancies (16%), and diabetes mellitus (14%) [ 8 ].…”

“…Cryptococcal endocarditis is extremely rare and hence is not extensively studied in the literature. A study published in 2020 identified 12 published cases and another case report was described in 2021 [ 4 , 5 ]. Unlike most of the previously reported cases of cryptococcus endocarditis , our case occurs in a patient without a history of underlying valvular pathology or a prosthetic valve.…”

“…Given the rarity of Cryptococcal endocarditis , there is lack of standard recommendations [ 3 , 4 ]. As of now, case reports have provided evidence that Amphotericin-B is a promising treatment in addition or in rare cases in-lieu of surgical intervention [ 9 ].…”

“…Given the possible resistance of cryptococcus to polyenes and the lack of standardized treatment for Cryptococcal endocarditis , other antifungals could be used in treatment. For example, Li et al [ 4 ] used initial amphotericin B and fluconazole with long-term flucytosine and fluconazole. Despite the benefits of using antifungals, specifically polyenes, mortality rates for medical treatment in cases of infective endocarditis are exceedingly high.…”

“…However, it is an unusual etiology for infective endocarditis. Cryptococcal endocarditis is an exceedingly rare form of endocarditis with only a few reported cases in the literature [ 3 , 4 ]. This infection typically occurs in patients with immunocompromised state and/or valvular heart disease particularly with prosthetic valves [ 5 ].…”