(643) Successful Pharmacological Treatment of Fungal Endocarditis in a Severely Burned Patient

Introduction: Burns are a leading cause of accidental injuries and fatalities worldwide. Post-burn infections are a major cause of death, with fungi, though uncommon, causing high morbidity and mortality. Fungal endocarditis, particularly from yeasts, is a severe complication and a significant treatment challenge, even with effective pharmacological options available

Description: We present a case of a 38-year-old man who was admitted to our critical burn unit after third-degree burns on 90% of his body surface during work-related activities, involving complete body immersion. The severity of the burns required a prolonged hospital stay and was associated with the development of multiple infections caused by oxidase-negative bacteria. During hospitalization, a 1x1 cm endocardial lesion was documented on the tricuspid valve, associated with the isolation of Candida auris in serial blood cultures. Fungal endocarditis was defined and evaluation by cardiovascular surgery deemed surgical intervention infeasible due to severe malnutrition, compromised skin condition, and overall patient fragility. Consequently, high doses of caspofungin combined with amphotericin were administered for 6 weeks, achieving microbiological clearance. After 9 months of hospitalization, the patient was discharged with no signs of active infection

Discussion: Native valve endocarditis is an uncommon disease, with an incidence ranging from 2 to 10 cases per 100.000 person-years. Data review suggests most cases belong to bacterial colonization with Gram-positive cocci. Meanwhile, fungal endocarditis is a far more difficult disease to come by, with its incidence rate not overcoming 3% of cases. Within the spectrum of infectious disease in critical burn patients, fungal infections are associated with high mortality. In the scenario of infective endocarditis, Candida isolation is an inherent indication for emergent surgical intervention. However, given the high mortality scores associated and the skin conditions of a burn patient, surgical options are poorly considered. Previous reports in the literature have implemented high-dose antifungal strategies as compassion therapy, in this particular case, combined therapeutic regimens with antifungals were implemented, demonstrating efficacy even in patients with such compromised conditions