Candida Parapsilosis Endocarditis in a Patient with MitraClip©: A Case Report

Fungal endocarditis is an uncommon form of endocarditis that is increasing in incidence. Our case involves a 73-year-old male with MitraClip© receiving chronic fluconazole therapy. The patient presented to the emergency department due to left upper quadrant abdominal pain. Imaging suggested splenic infarct, so there was concern for emboli; however, transthoracic echocardiography did not reveal valvular vegetations on the areas visualized. The patient had a history of fungemia, so blood cultures were obtained prior to starting prophylactic antifungal therapy. The blood cultures revealed Candida parapsilosis, and transesophageal echocardiography revealed valvular vegetations. The antifungal regimen was modified, and the patient was referred to an outside facility for surgical evaluation. At the outside facility, the patient underwent mitral valve replacement, tricuspid valve repair, and splenectomy. Surgical pathology confirmed Candida parapsilosis. The fungus was also found in the patient’s spleen. The patient then completed an antifungal regimen while inpatient. He is taking a suppressive regimen of fluconazole currently. To our knowledge, this is the first case of Candida parapsilosis endocarditis in a patient with MitraClip© receiving chronic fluconazole therapy.