复发性真菌性心内膜炎1例及文献复习

摘要

56岁的女性患者,因"反复乏力、纳差、发热1年余,再发2个月并突发左侧肢体抽动10 d"入院.2017年患者被确诊为感染性心内膜炎后行主动脉瓣置换术,瓣膜活检示近平滑假丝酵母菌,术后患者规律服药,连续3次血培养阴性后停药.2018年患者再次出现发热并发多器官梗死,血培养再次分离出近平滑假丝酵母菌.提示真菌性心内膜炎可在人体内长期潜伏、复发,赘生物脱落可栓塞各个器官导致相应的临床表现,手术联合药物治疗以及后续维持抗真菌治疗对改善患者的预后极其重要.%A 56-year-old female patient was admitted to a hospital because of repeated fatigue, anorexia, fever for more than one year, recurrence for 2 months and sudden left limb twitch for 10 days. In 2017, patient was diagnosed with infective endocarditis, then underwent aortic valve replacement, valve biopsy showed Candida parapsilosis, she took medicine regularly after operation and withdrew medicine after three consecutive negative blood culture. Fever and multiple organ infarction occurred again in 2018, Candida parapsilosis was isolated again from blood culture, it is suggested that fungal endocarditis may be latent and recurrence in human body for a long time, exfoliation of vegetation may embolize various organs and lead to corresponding clinical manifestations, surgery combined with drug therapy and subsequent maintenance of antifungal therapy are extremely important to improve the prognosis of patients.