AngioVac-assisted management of histoplasma capsulatum endocarditis in a bioprosthetic aortic valve: challenges and outcomes.

BACKGROUND: Histoplasma capsulatum infective endocarditis (IE) is rare and often fatal, especially in prosthetic valve patients, due to delayed diagnosis and limited therapeutic options. This case demonstrates the utility of AngioVac for managing large fungal vegetations, underscores the importance of considering fungal IE in culture-negative cases, and highlights the role of a multidisciplinary approach in high-risk patients. We report a 76-year-old female with a bioprosthetic aortic valve who presented with persistent culture-negative fever, splenic infarcts, and large vegetations on her prosthetic valve. Extensive diagnostic workup confirmed fungal endocarditis after AngioVac-assisted debulking revealed H. capsulatum on tissue cultures. Despite prompt initiation of antifungal therapy and multidisciplinary management, her course was complicated by recurrent embolic events, septic shock, and eventual death.

CONCLUSION: This case underscores the importance of considering fungal IE in culture-negative cases, especially in high-risk patients such as those with prosthetic valves. It also highlights the role of advanced diagnostic techniques and minimally invasive interventions like AngioVac in managing complex cases, despite their limitations.