Surviving a recurrent S. prolificans endocarditis : A case r
Scedosporium prolificans have been reported to be resistant to all antifungals including the newer azoles and echinocandins. Published in the Indian Journal of Medical Microbiology, the authors report an unusual case of repeated S. prolificans infection of the heart valves in an immunocompetent patient.

A 50-year-old, non-hypertensive, diabetic male was referred for frequent episodes of breathlessness and cough with intermittent fever. Echocardiography done at admission revealed a large echogenic osculating mass attached to the tricuspid valve measuring 23 mm × 20 mm causing severe tricuspid regurgitation. Laboratory parameters sent at the time of admission were within normal limits and blood was sent for fungal culture.

Patient had undergone permanent pacemaker implantation in October 2009 which was upgraded to cardiac resynchronisation therapy defibrillator in October 2011. Since January 2012, the patient started to have frequent episodes of fever and was diagnosed as having device related tricuspid valve endocarditis.

He underwent tricuspid valve replacement in September 2012. Culture of the valve tissue grew S. prolificans. Patient was put on liposomal amphotericin B for 3 weeks and discharged on a combination of posaconazole and voriconazole.

Epicardial lead implantation and tricuspid valve replacement were done within 2 weeks of admission. Direct microscopy of the valve tissue showed hyaline septate hyphae and culture grew S. prolificans both from the valve tissue and blood culture. Identification of the isolate was done based on macroscopic and microscopic features. Although no interpretive breakpoints exist for Scedosporium, in vitrodrug sensitivity was done by broth microdilution technique using Sensititre YeastOn.

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