Catheter Related Candida guilliermondii Endocarditis with Intracardiac Fungal Ball

Catheter Related Candida guilliermondii Endocarditis with Intracardiac Fungal Ball | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Catheter Related Candida guilliermondii Endocarditis with Intracardiac Fungal Ball Mushahid Hussain Goraya, Wardah Khalid Rafat This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8970589/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Fungal endocarditis is a rare but highly lethal infection, often associated with central venous catheters and immunocompromised states. While Candida albicans is the most common pathogen, non-albicans species like Candida guilliermondii are emerging and may exhibit reduced susceptibility to standard antifungal agents. The purpose of this case report is to highlight a successful medical management strategy for a large intracardiac fungal mass in a patient deemed inoperable due to severe malnutrition. The patient, a woman in her 30s dependent on a peripherally inserted central catheter (PICC) for parenteral nutrition, presented with fever and shock. Diagnostic methods included blood cultures, which identified C. guilliermondii, and echocardiography, which revealed multiple vegetations on the mitral and tricuspid valves along with a large echogenic mass on the right atrial wall. Following PICC removal, the patient was treated with a 16-week staged antifungal regimen consisting of intravenous Amphotericin B, followed by Caspofungin, and concluding with oral Fluconazole. Results showed complete clinical and radiological resolution. Serial echocardiograms over eight months confirmed the total disappearance of the intracardiac mass and vegetations, leaving only mild residual tricuspid regurgitation. This case concludes that aggressive, prolonged medical therapy guided by susceptibility data and source control offers a viable alternative to surgery. It demonstrates that definitive cure is achievable even in high-risk, inoperable cases of fungal endocarditis through optimized antifungal protocols and rigorous serial imaging. Fungal endocarditis fungoma cardiac imaging fungal ball Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Case Report A woman in her 30s presented with a 10-day history of high-grade fever. Nine months earlier, she underwent surgery for ileal perforation due to enteric fever, followed by ileostomy and later reversal complicated by intestinal leak, requiring repeat laparotomy and colostomy. She remained on parenteral nutrition via a Peripherally inserted central catheter (PICC) for two months, developing severe malnutrition (albumin 1.8 g/dL, lymphopenia, 8 kg weight loss). On admission, she was critically ill with shock (BP 70/50 mmHg), tachycardia, pallor, and a grade 3/6 pansystolic murmur at the right parasternal border. Laboratory investigations were suggestive of sepsis (Table 1). Transthoracic echocardiogram (TTE) revealed vegetations on the mitral and tricuspid valves and a large mobile echogenic mass attached to the right atrial wall (Fig. 1–6). The PICC was removed, and empirical antibiotics were started. Blood cultures from the PICC grew Candida guilliermondii . CT chest/abdomen showed no embolic complications, and ophthalmologic evaluation excluded endophthalmitis. She received a three-phase antifungal regimen: Intravenous (IV) Amphotericin B for 7 days, IV Caspofungin for 6 weeks, and then oral Fluconazole for 9 weeks (total 16 weeks). Anticoagulation with Apixaban was maintained throughout due to high risk of thrombus formation. Surgical intervention was deferred due to high operative risk. The patient improved clinically, with resolution of fever and normalization of inflammatory markers. Patient was followed over 8 months with serial echocardiograms confirming complete resolution of vegetations and the atrial fungal mass with negative inflammatory markers throughout this period. She remains stable on secondary prophylaxis with oral Fluconazole. Discussion Candida albicans is the most common cause of fungal endocarditis 7 , but non-albicans species such as Candida guilliermondii are emerging and often show reduced susceptibility to azoles and echinocandins 1 , 3 . Our patient’s malnutrition and prolonged PICC-based parenteral nutrition were major risk factors for candidemia 2 , 5 . A notable feature was the large right atrial fungal ball, a severe manifestation of fungal endocarditis. Complete resolution was achieved with a prolonged and staged antifungal regimen 7 guided by susceptibility testing and source control. This case demonstrates that optimized medical therapy can achieve cure in high-risk patients unsuitable for cardiac surgery 4 and serial echocardiography is crucial to monitor resolution and guide therapy duration. Conclusion This case underscores the critical importance of considering fungal endocarditis in patients with long-term central venous access and severe malnutrition, even in younger populations. While surgical intervention remains the gold standard for large vegetations and fungal masses, our experience demonstrates that a multidisciplinary, staged medical approach can be curative when surgery is contraindicated. Statements and Declarations The authors declare that they have no competing interests, financial or otherwise, related to the materials or methods presented in this report. This case report received no fundings and is purely for academic purposes with no financial interests. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. This case report was conducted purely for academic purposes with no financial interests or external institutional support. Author Contribution M.H.G. conceived the case report, was part of the clinical management of the patient, performed the literature review, and drafted the primary manuscript.W.K.R. assisted in writing the manuscript and prepared all figures and tables.All authors reviewed and approved the final version of the manuscript. Data Availability Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. All clinical information pertinent to the case is included within the published article. Consent to Publish Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. The patient’s identity has been fully anonymized to protect their privacy in accordance with ethical guidelines for clinical reporting. A copy of the written consent is available for review by the Editor-in-Chief of this journal upon request. References Zheng Z, Tu X, Jiang C, Liu F, Fan C. First case report of Candida guilliermondii native left-sided valve endocarditis. Front Cardiovasc Med. 2023;10:1273255. 10.3389/fcvm.2023.1273255 . Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev. 2007;20(1):133–63. 10.1128/CMR.00029-06 . Saravana Priya JK, Balasubramaniam GM, Ramani CP. Candida guilliermondii endocarditis in a patient with prosthetic mitral valve: a case report. Curr Med Mycol. 2025;11:1654. 10.22034/cmm.2025.345248.1654 . Jang Y, Song JK, Yun SC, Park DW, Kang DH, Lee JW. Predictors of adverse outcome in patients with fungal endocarditis. Am J Cardiol. 2011;108(4):570–5. Wang N, Zhang J, Du Z, Li J, Chen Y, Zhao H. Risk factors for recurrent infective endocarditis in persons who inject drugs: the role of PICC line abuse. J Am Coll Cardiol. 2019;73(20):2563–70. Ellis ME, Al-Abdely H, Sandridge A, Greer W, Ventura W. Fungal endocarditis: evidence in the world literature, 1965–1995. Clin Infect Dis. 2001;32(1):50–62. 10.1086/317550 . Baddley JW, Benjamin DK Jr, Patel M, Miró JM, Athan E, Barsic B, et al. Candida infective endocarditis: report of 72 cases from the International Collaboration on Endocarditis–Prospective Cohort Study. Eur J Clin Microbiol Infect Dis. 2008;27(7):519–29. 10.1007/s10096-008-0466-x . Table Table 1 Initial Laboratory Findings on Admission Test Name Result Reference Range Units Hemoglobin 8.9 11–14.5 g/dL White Blood Cells Neutrophils Lymphocytes 9.3 96% 3.0% 4.6–10.8 x10^9/L Platelets 29 154–433 x10^9/L C-Reactive Protein 96.40 0–14 mg/L Procalcitonin 23.30 < 0.5 ng/mL Serum Albumin 2.0 3.5–5.2 g/dL Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 16 Apr, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviewers invited by journal 16 Apr, 2026 Editor assigned by journal 06 Mar, 2026 Submission checks completed at journal 06 Mar, 2026 First submitted to journal 25 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8970589","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":625353145,"identity":"87fe03f6-9eff-4b52-82bb-d8824e67e353","order_by":0,"name":"Mushahid Hussain Goraya","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYHACNgbGBgkgAnMkGPiBAkDATIIWyQbitDDAtDAwGBwgoEV3RvqzBz93WMg2SPcYf/xRY5FnfPxYmgRDhXViAw4tZjdyzA17z0gYN8icMZPmOSZRbHYm7ZgEw5l0fFrYJHjbJBIbJHLMmBnYJBK3HUhvk2BsO4xHS/ozyb8QLUCH/ZNI3Nz/HKjlHz4tCWbSUFsMwNZtkAA6jLEBj5Yzb8ykZdskjNsk0sqkefskEmfceJZskXAs3RinluNAh71tq5Ptl0je/PHHt7rE/v40wxsfaqxlcWmBAzYUXgIh5aNgFIyCUTAK8AIAmWpYjgH9L4EAAAAASUVORK5CYII=","orcid":"","institution":"Aga Khan University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Mushahid","middleName":"Hussain","lastName":"Goraya","suffix":""},{"id":625353147,"identity":"33254807-1349-4cf5-bd90-c192cb8d3f2b","order_by":1,"name":"Wardah Khalid Rafat","email":"","orcid":"","institution":"Ziauddin University","correspondingAuthor":false,"prefix":"","firstName":"Wardah","middleName":"Khalid","lastName":"Rafat","suffix":""}],"badges":[],"createdAt":"2026-02-25 18:38:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8970589/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8970589/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107676113,"identity":"1af9a0c7-bb36-4e07-8a97-2b5a389942a1","added_by":"auto","created_at":"2026-04-24 00:49:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":676229,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParasternal long-axis view demonstrating vegetation on the anterior mitral leaflet (red box) and posterior mitral leaflet (blue box).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8970589/v1/d8703663480fa8d545e46d80.png"},{"id":107708056,"identity":"8db816bd-20a9-40cc-b85d-d6b6d6fbe5d6","added_by":"auto","created_at":"2026-04-24 09:21:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":545520,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParasternal long-axis view demonstrating a large mobile vegetation on the anterior mitral leaflet (red arrow) and a large vegetation on the posterior mitral leaflet (blue arrow).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8970589/v1/6c4f725ed20962c3fef26266.png"},{"id":107706813,"identity":"15dcd8bd-d1d7-4e73-a7f2-07a5526aaceb","added_by":"auto","created_at":"2026-04-24 09:18:48","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":681961,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eApical four-chamber view demonstrating a large, mobile echogenic density within the right atrium (red box).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8970589/v1/cd47f55628d2fb1b51113139.png"},{"id":107676115,"identity":"81142944-02a0-46ac-94aa-eac8bccb526c","added_by":"auto","created_at":"2026-04-24 00:49:36","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":714106,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eModified apical four-chamber view demonstrating a broad-based echogenic density attached to the right atrial free wall, prolapsing through the tricuspid valve (red box).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8970589/v1/0da2a03bb7293663d51aa264.png"},{"id":107676116,"identity":"cb724f45-8dcb-4ca8-a2b3-36462939be00","added_by":"auto","created_at":"2026-04-24 00:49:36","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":679720,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eApical four-chamber view demonstrating a small vegetation attached to the tricuspid valve.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8970589/v1/063bf142132c2adf74d39a18.png"},{"id":107676118,"identity":"355ffd50-55b9-4ff1-b22e-6c42dd4f4b27","added_by":"auto","created_at":"2026-04-24 00:49:36","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":507447,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSubcostal view demonstrating an echogenic density within the right atrium, with no extension into the inferior vena cava.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-8970589/v1/116a9f1d3f923eca6cd47c69.png"},{"id":107709363,"identity":"1ad39c93-9b9f-4a97-b6c7-1d84b23b5984","added_by":"auto","created_at":"2026-04-24 09:35:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4850938,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8970589/v1/fe84ac01-843a-4b83-8607-b30600c771d7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Catheter Related Candida guilliermondii Endocarditis with Intracardiac Fungal Ball","fulltext":[{"header":"Case Report","content":" \u003cp\u003eA woman in her 30s presented with a 10-day history of high-grade fever. Nine months earlier, she underwent surgery for ileal perforation due to enteric fever, followed by ileostomy and later reversal complicated by intestinal leak, requiring repeat laparotomy and colostomy. She remained on parenteral nutrition via a Peripherally inserted central catheter (PICC) for two months, developing severe malnutrition (albumin 1.8 g/dL, lymphopenia, 8 kg weight loss).\u003c/p\u003e \u003cp\u003eOn admission, she was critically ill with shock (BP 70/50 mmHg), tachycardia, pallor, and a grade 3/6 pansystolic murmur at the right parasternal border. Laboratory investigations were suggestive of sepsis (Table\u0026nbsp;1). Transthoracic echocardiogram (TTE) revealed vegetations on the mitral and tricuspid valves and a large mobile echogenic mass attached to the right atrial wall (Fig.\u0026nbsp;1\u0026ndash;6). The PICC was removed, and empirical antibiotics were started. Blood cultures from the PICC grew \u003cem\u003eCandida guilliermondii\u003c/em\u003e. CT chest/abdomen showed no embolic complications, and ophthalmologic evaluation excluded endophthalmitis.\u003c/p\u003e \u003cp\u003eShe received a three-phase antifungal regimen: Intravenous (IV) Amphotericin B for 7 days, IV Caspofungin for 6 weeks, and then oral Fluconazole for 9 weeks (total 16 weeks). Anticoagulation with Apixaban was maintained throughout due to high risk of thrombus formation. Surgical intervention was deferred due to high operative risk. The patient improved clinically, with resolution of fever and normalization of inflammatory markers. Patient was followed over 8 months with serial echocardiograms confirming complete resolution of vegetations and the atrial fungal mass with negative inflammatory markers throughout this period. She remains stable on secondary prophylaxis with oral Fluconazole.\u003c/p\u003e "},{"header":"Discussion","content":" \u003cp\u003e \u003cem\u003eCandida albicans\u003c/em\u003e is the most common cause of fungal endocarditis\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, but non-albicans species such as \u003cem\u003eCandida guilliermondii\u003c/em\u003e are emerging and often show reduced susceptibility to azoles and echinocandins\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Our patient\u0026rsquo;s malnutrition and prolonged PICC-based parenteral nutrition were major risk factors for candidemia\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. A notable feature was the large right atrial fungal ball, a severe manifestation of fungal endocarditis. Complete resolution was achieved with a prolonged and staged antifungal regimen\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e guided by susceptibility testing and source control. This case demonstrates that optimized medical therapy can achieve cure in high-risk patients unsuitable for cardiac surgery\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e and serial echocardiography is crucial to monitor resolution and guide therapy duration.\u003c/p\u003e "},{"header":"Conclusion","content":"\u003cp\u003eThis case underscores the critical importance of considering fungal endocarditis in patients with long-term central venous access and severe malnutrition, even in younger populations. While surgical intervention remains the gold standard for large vegetations and fungal masses, our experience demonstrates that a multidisciplinary, staged medical approach can be curative when surgery is contraindicated.\u003c/p\u003e "},{"header":"Statements and Declarations","content":"\u003cp\u003eThe authors declare that they have no competing interests, financial or otherwise, related to the materials or methods presented in this report. This case report received no fundings and is purely for academic purposes with no financial interests.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript. This case report was conducted purely for academic purposes with no financial interests or external institutional support.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.H.G. conceived the case report, was part of the clinical management of the patient, performed the literature review, and drafted the primary manuscript.W.K.R. assisted in writing the manuscript and prepared all figures and tables.All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData sharing is not applicable to this article as no datasets were generated or analyzed during the current study. All clinical information pertinent to the case is included within the published article.\u003c/p\u003e\n\u003ch3\u003eConsent to Publish\u003c/h3\u003e\n\u003cp\u003e Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. The patient\u0026rsquo;s identity has been fully anonymized to protect their privacy in accordance with ethical guidelines for clinical reporting. A copy of the written consent is available for review by the Editor-in-Chief of this journal upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZheng Z, Tu X, Jiang C, Liu F, Fan C. First case report of Candida guilliermondii native left-sided valve endocarditis. Front Cardiovasc Med. 2023;10:1273255. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fcvm.2023.1273255\u003c/span\u003e\u003cspan address=\"10.3389/fcvm.2023.1273255\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev. 2007;20(1):133\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1128/CMR.00029-06\u003c/span\u003e\u003cspan address=\"10.1128/CMR.00029-06\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaravana Priya JK, Balasubramaniam GM, Ramani CP. Candida guilliermondii endocarditis in a patient with prosthetic mitral valve: a case report. Curr Med Mycol. 2025;11:1654. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.22034/cmm.2025.345248.1654\u003c/span\u003e\u003cspan address=\"10.22034/cmm.2025.345248.1654\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJang Y, Song JK, Yun SC, Park DW, Kang DH, Lee JW. Predictors of adverse outcome in patients with fungal endocarditis. Am J Cardiol. 2011;108(4):570\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang N, Zhang J, Du Z, Li J, Chen Y, Zhao H. Risk factors for recurrent infective endocarditis in persons who inject drugs: the role of PICC line abuse. J Am Coll Cardiol. 2019;73(20):2563\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEllis ME, Al-Abdely H, Sandridge A, Greer W, Ventura W. Fungal endocarditis: evidence in the world literature, 1965\u0026ndash;1995. Clin Infect Dis. 2001;32(1):50\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1086/317550\u003c/span\u003e\u003cspan address=\"10.1086/317550\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaddley JW, Benjamin DK Jr, Patel M, Mir\u0026oacute; JM, Athan E, Barsic B, et al. Candida infective endocarditis: report of 72 cases from the International Collaboration on Endocarditis\u0026ndash;Prospective Cohort Study. Eur J Clin Microbiol Infect Dis. 2008;27(7):519\u0026ndash;29. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10096-008-0466-x\u003c/span\u003e\u003cspan address=\"10.1007/s10096-008-0466-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eInitial Laboratory Findings on Admission\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTest Name\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eResult\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eReference Range\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnits\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHemoglobin\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.9\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e11\u0026ndash;14.5\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eg/dL\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eWhite Blood Cells\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eNeutrophils\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eLymphocytes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e9.3\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e96%\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e3.0%\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e4.6\u0026ndash;10.8\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003ex10^9/L\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePlatelets\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e29\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e154\u0026ndash;433\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003ex10^9/L\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eC-Reactive Protein\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e96.40\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u0026ndash;14\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003emg/L\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eProcalcitonin\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e23.30\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.5\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eng/mL\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSerum Albumin\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.5\u0026ndash;5.2\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eg/dL\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-rare-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Journal of Rare Diseases](https://link.springer.com/journal/44162)","snPcode":"44162","submissionUrl":"https://submission.nature.com/new-submission/44162/3","title":"Journal of Rare Diseases","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Fungal endocarditis, fungoma, cardiac imaging, fungal ball","lastPublishedDoi":"10.21203/rs.3.rs-8970589/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8970589/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Fungal endocarditis is a rare but highly lethal infection, often associated with central venous catheters and immunocompromised states. While Candida albicans is the most common pathogen, non-albicans species like Candida guilliermondii are emerging and may exhibit reduced susceptibility to standard antifungal agents. The purpose of this case report is to highlight a successful medical management strategy for a large intracardiac fungal mass in a patient deemed inoperable due to severe malnutrition.\n\nThe patient, a woman in her 30s dependent on a peripherally inserted central catheter (PICC) for parenteral nutrition, presented with fever and shock. Diagnostic methods included blood cultures, which identified C. guilliermondii, and echocardiography, which revealed multiple vegetations on the mitral and tricuspid valves along with a large echogenic mass on the right atrial wall. Following PICC removal, the patient was treated with a 16-week staged antifungal regimen consisting of intravenous Amphotericin B, followed by Caspofungin, and concluding with oral Fluconazole.\n\nResults showed complete clinical and radiological resolution. Serial echocardiograms over eight months confirmed the total disappearance of the intracardiac mass and vegetations, leaving only mild residual tricuspid regurgitation. This case concludes that aggressive, prolonged medical therapy guided by susceptibility data and source control offers a viable alternative to surgery. It demonstrates that definitive cure is achievable even in high-risk, inoperable cases of fungal endocarditis through optimized antifungal protocols and rigorous serial imaging.","manuscriptTitle":"Catheter Related Candida guilliermondii Endocarditis with Intracardiac Fungal Ball","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-24 00:49:32","doi":"10.21203/rs.3.rs-8970589/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-16T14:50:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"98621900565076140664764727720303993259","date":"2026-04-16T11:15:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-16T08:02:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-06T14:44:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-06T14:38:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Rare Diseases","date":"2026-02-25T18:24:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-rare-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Journal of Rare Diseases](https://link.springer.com/journal/44162)","snPcode":"44162","submissionUrl":"https://submission.nature.com/new-submission/44162/3","title":"Journal of Rare Diseases","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0b0ef518-436f-47da-8197-5c9ed52df457","owner":[],"postedDate":"April 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-24T00:49:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-24 00:49:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8970589","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8970589","identity":"rs-8970589","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}