Polymicrobial Pseudomonas Plus Candida Parapsilosis Endocarditis in an Injection Drug User: Considerations for Diagnosis and Management

Fungal endocarditis (FE) is a potentially lethal condition and its diagnosis can be challenging due to the low yield from blood cultures. FE should be suspected in patients with associated risk factors despite the identification of positive bacterial blood cultures. The common risk factors for FE discussed in the literature are total parenteral nutrition, immune suppression, prior antimicrobial therapy, intravenous drug addiction, and cardiac surgery. In this report, we discuss a patient who had positive blood cultures for Pseudomonas but was found to have Candida parapsilosis on valve culture. Physicians need to maintain a high index of suspicion for co-infective endocarditis in this patient population.