Cerebral Hemorrhage as an Initial Manifestation of Left Ventricular Assist Device-Related Systemic Candidemia.

BACKGROUND

Infections remain a major complication in patients with left ventricular assist devices (LVADs).

CASE SUMMARY: A 51-year-old male with a history of LVAD implantation presented with vertigo and was found to have an occipital cerebral hemorrhage. Further evaluation revealed a ruptured infectious intracranial aneurysm. Blood cultures confirmed Candida parapsilosis, and 18F-fluorodeoxyglucose-position emission tomography/computed tomography demonstrated abnormal uptake at the outflow graft and driveline, providing adjunctive evidence suggestive of LVAD-related infection. He was successfully treated with micafungin and liposomal amphotericin B without LVAD exchange.

DISCUSSION: This case emphasizes the importance of considering systemic fungal infection in LVAD patients even in the absence of fever or elevated inflammatory markers. Early recognition with blood cultures and advanced imaging is essential to guide management.

TAKE-HOME MESSAGES: Systemic fungal infection should be suspected in LVAD patients with unexplained weight loss or a ruptured intracranial aneurysm, even without fever. Early blood cultures and advanced imaging are essential for timely diagnosis.