Death due to fungal endocarditis – a case report

Sudden deaths of cardiac origin are usually caused by unexpected loss of heart function. One of the causes may be Infective endocarditis (IE) which refers to the microbial infection of the heart valves or mural endocardium that leads to the formation of thrombotic vegetations that cause calcification and destruction of underlying cardiac tissue. The vegetations are typically friable and embolize easily causing abscesses (Ring abscess), septic infarcts and mycotic aneurysms. Left untreated, IE may lead to congestive heart failure (CHF). Hence, it is important to discuss cases where IE was the main cause for death. Case suggested of a 67-year-old female who developed breathlessness, was taken to a local hospital and later brought to a multi-speciality hospital on the advice of doctors where she was declared brought dead. Internal Examination revealed the brain to be soft, congested and oedematous. There was coning of the orbital part of the frontal lobe, uncal part of the hippocampal gyrus of the temporal lobe and the cerebellar tonsil bilaterally. Tracheal lumen contained blood stained mucoid fluid. White patch was present on the anterior surface of the right ventricle 4 cm above apex. Right coronary artery showed 50% occlusion in its entire course. Left anterior descending artery showed 75% occlusion for 4cm from its origin. Multiple atheromatous streaks and plaques were present over the aortic intima at several places. Histopathology suggested chronic myocardial infarct with left coronary artery atherosclerosis. Pseudo hyphae were noticed in the vegetation's on the heart valve which were confirmed to be belonging to the genus Candida. Final opinion as to the cause of death after hospital records, autopsy findings, histopathology report and RFSL reports-due to sequelae of fungal infective endocarditis.