Conclusion
C. parapsilosis is a rare cause of fungal endocarditis, commonly associated with IVDU. C. parapsilosis endocarditis has a predilection for the aortic valve and is more common in patients with bioprosthetic valves. It has a high mortality of about 40%. Our case presents a patient with risk factors for invasive fungal infection (IVDU and splenomegaly) who developed C. parapsilosis endocarditis, first of her native aortic valve and subsequently of her bioprosthetic valve. One of the challenging aspects of this case was the recurrent presentations C. parapsilosis candidemia and the persistent candidemia despite appropriate use of recommended first-line antifungal therapy, necessitating trials of multiple first-line therapies. The organism’s ability to form biofilms is suspected to be the significant contributing factor to the persistent and relapsing nature of invasive infections caused by this organism.
C. parapsilosis endocarditis has a high mortality rate that approaches 40%. As the aortic valve is most commonly affected, there is often involvement of many organ systems due to septic embolization. High clinical suspicion and a multidisciplinary approach is needed in these cases to reduce morbidity and prevent mortality.