Synergistic eradication of Candida albicans prosthetic valve endocarditis with liposomal amphotericin B and high-dose caspofungin: a case report

Prosthetic valve endocarditis (PVE) due to Candida albicans was diagnosed in a 58-year-old woman 1 year after mitral bioprosthetic replacement for severe regurgitation. The diagnosis was prompted by recurrent fever and confirmed by positive blood cultures and echocardiographic vegetations. The isolate was susceptible to amphotericin B, azoles, and echinocandins. Despite meeting surgical criteria, the patient declined reoperation. Salvage therapy with liposomal amphotericin B combined with high-dose caspofungin successfully resolved symptoms and led to vegetation regression on follow-up imaging. The patient was discharged on lifelong suppressive antifungal therapy based on susceptibility profiling.