Histoplasma capsulatum prosthetic valve endocarditis treated with oral isavuconazole

<i>Histoplasma capsulatum</i> remains the most common cause of systemic fungal infections in the United States, with severe cases occurring in older adults, immunosuppressed individuals, and those with lung disease. Despite its prevalence in systemic and pulmonary illness, histoplasmosis endocarditis is an unlikely source of mycotic endocarditis, with limited updated guidelines on antifungal therapy. We present a case of artificial valve <i>histoplasma</i> endocarditis requiring surgery and antifungal therapy. Isavuconazole was selected through shared decision-making due to concerns about the tolerability of traditional agents. The patient was successfully treated with a combination of aortic valve replacement and isavuconazole therapy.