İlkay KARAOĞLAN, M. Armağan TOY, Mustafa NAMIDURU, Ysemin ZER, Vedat DAVUTOĞLU

Medikal tedavi ile düzelen candida albicans’ın etken olduğu protez kapak endokarditi olgusu

Yirmiyedi yaşında kadın hasta, metisilin dirençli Staphylococcus aureus’un etken olduğu triküspit kapak endokarditi tanısı ile 1 ay vankomisin tedavisi almıştır. Medikal tedaviden tam yanıt alınamadığından hastaya kapak replasmanı yapılıp bioprotez kapak takılmış, vankomisin tedavisine 4 hafta daha devam edilmiştir. Hasta ortalama 7 ay sonra Candida albicans’ın etken olduğu fungal endokardit tanısı ile yatırılmıştır. Operasyon riskleri göz önüne alınarak hastaya öncelikli olarak klasik amfoterisin B ve flusitozin kombinasyonundan oluşan medikal tedavi başlanmıştır. Hastanın tedaviye yanıt vermesinden dolayı medikal tedaviye devam edilmiş, operasyon ertelenmiştir. Medikal tedavi 12 haftaya tamamlandığında hastanın ekokardiyografik incelemesinde protez kapaktaki vejetasyon tamamen kaybolmuştur. Hastanın 6 aylık takibinde klinik ve laboratuvar bulguları normal olarak değerlendirilmiştir.

A case of candida albicans prosthetic valve endocarditis cured with medical treatment

A 27 year old female patient with tricuspit valve endocarditis due to methicillin-resistant Staphylococcus aureus was treated with vancomycin for one month. Since good response couldn’t be taken from the medical treatment, the patient underwent to valve replacement and bioprosthetic valve was implanted and vancomycin therapy was continued for 4 weeks. Approximately 7 months later, the patient was hospitalized with diagnosis of fungal endocarditis due to Candida albicans as etiological agent. In view of the operation risks, medical treatment consisted of the combination of amphotericin B and flucytocine was started. Because of the good responses, medical treatment was continued and the operation was postponed. Finally, medical treatment was completed to 12 weeks. The vegetation on prosthetic valve detected by echocardiography was completely disappeared. In the follow up of the patient for 6 months, clinical and laboratory findings were evaluated as normal.

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