Fungal endocarditis complicating intracranial multifocal hemorrhages: a case report

Fungal endocarditis carries a high mortality rate, with intracranial multifocal hemorrhage representing a severe yet rarely reported complication. We present a case of a 60-year-old female with a history of rheumatic valvular disease who underwent bioprosthetic mitral valve replacement and developed fungal endocarditis with vegetation formation 12 years postoperatively. Following antifungal therapy, the patient underwent redo mitral valve replacement. The postoperative course was complicated by acute subdural hematoma, subarachnoid hemorrhage, and cerebral herniation, necessitating emergent burr hole drainage. Multidisciplinary management achieved hemodynamic stabilization, though with residual neurological deficits including hemiplegia and dysphagia.This case highlights the critical risk of fatal intracranial hemorrhage during the perioperative period of fungal endocarditis, underscoring the need for enhanced monitoring and proactive intervention. The clinical course provides valuable insights for managing such life-threatening complications.