Endocarditis in a Very Low Birth Weight Premature Infant Successfully Treated with the Association of Caspofungin and Voriconazole

Objectives To report a case in where a mural endocarditis caused by Candida parapsilosis was successfully treated with the combination of 2 antifungal agents, caspofungin and voriconazole, in an extremely premature infant. Description A female infant born at 30.7 weeks with weight 925 g. The infant had a pneumothorax and respiratory distress syndrome, requiring prolonged mechanical ventilation, 1 venous umbilical and 3 central catheters, and broad-spectrum antibiotics. At 51 days of life, an echocardiogram showed an image compatible with fungal vegetation on the junction of the superior vena cava to the right atrium. Blood cultures grew Candida parapsilosis in various sequential samples, despite treatment with fluconazole and amphotericin-B and in vitro sensitivity to these drugs. A treatment of combined voriconazole and caspofungin was initiated resulting in clinical improvement and no need for surgical removal of vegetation. Comments Combined therapy with newer antifungal agents can be life-saving in premature infants with Candida parapsilosis complicated sepsis