Fungal endocarditis complicated by shock in the course of long-term permanent cardiac pacing

The case is presented of a 52-year-old female patient who was diagnosed as having fungal endocarditis due to the Mucor species infection. The patient had had permanent cardiac pacing for 23 years. She was admitted to the hospital with symptoms of sepsis, and TTE revealed the development of vegetations on the pacemaker leads. Cardiac surgery with removal of the infected system was performed and a new pacemaker with an epicardial lead was implanted. After the surgery the patient's clinical course was complicated by multiple organ dysfunction syndrome and septic shock, which was resistant to traditional treatment. Admin- istration of human recombinant activated protein C (Xigris) improved organ function and enabled selective antifungal therapy to be continued. The patient was discharged from hospital 48 days later in a good condition. (Folia Cardiol. 2006; 13: 344-347)