A Case of Fungal Prosthetic Valve Endocarditis Complicated by Embolic ST-Elevated Myocardial Infarction

Acute coronary syndrome (ACS) is a rare complication of infective endocarditis (IE) and is associated with high mortality. Typically, coronary artery occlusion is a complication of bacterial autologous valve IE. We present the case of a 74-year-old woman with a history of aortic valve replacement for aortic stenosis who was receiving immunosuppressive therapy for rheumatoid arthritis. Upon admission, she was diagnosed with ST- elevation myocardial infarction (STEMI), and coronary angiography (CAG) revealed complete occlusion in the terminal branches of the left circumflex coronary artery (LCX #12 and #14). On day 3 of admission, threedimensional transesophageal echocardiography (3D-TEE) was performed, and vegetation was detected, leading to IE diagnosis. The patient underwent prosthetic valve replacement on day 4. Subsequent blood cultures grew Candida albicans, and histopathological examination using Grocott staining confirmed the presence of Grocott-positive fungi within the vegetation, leading to a definitive diagnosis of prosthetic valve endocarditis (PVE) caused by Candida albicans; this management resulted in favorable outcomes. The present case suggests that fungal PVE can also complicate STEMI, and real-time 3D-TEE was instrumental in diagnosing and accurately assessing the vegetation in this condition.