Native Valve Endocarditis Due to Trichosporon mycotoxinivorans—An Uncommon Presentation

Trichosporon is a type of non-candida yeast-like fungus. At one time, it was commonly reported in immunocompromised patients, but after the introduction of fluconazole as prophylaxis and for the treatment of fungal infections, there was a decrease in the incidence of the disease. With the introduction of echinocandins as the first line of treatment for fungal infections, and the intrinsic resistance of Trichosporon to the drug, there has been a small but increased reported incidence of the disease. Trichosporon usually causes skin infections, but invasive disease can occur in vulnerable patients. Endocarditis due to Trichosporon has been reported rarely, and usually occurs in prosthetic valves. In this paper, we report a patient with dialysis-dependent chronic kidney disease who presented with fever and was found to have native aortic valve endocarditis. In view of the large vegetation, he underwent early aortic valve replacement. Both the blood and tissue cultures grew Trichosporon spp. Post-operatively, he developed fungal septic shock, deteriorated, and died. Invasive Trichosporon disease has been associated with high rates of mortality ranging from 30 to 90%. There is limited literature on endocarditis resulting from Trichosporon. Specific treatment recommendations are unavailable, and a combination of surgery and prolonged antifungal medication will generally be required.