case_images: PMC10624219_01
case_images: (A) Transthoracic echocardiography showed a vegetation lesion adherent to the patient's anterior mitral leaflet, which was concerning for infectiousendocarditis. (B-D) Culture and microscopic characteristics of L. elongisporusfrom the patient. Blood culture growth of cream-colored colonies on Sabouraud dextrose agar (B), chocolate agar (C), and Columbia CNA bloodagar plates (D) after 24 h of incubation at 35 C. (E) Microscopy of the blood smear revealed ellipsoidal to elongated blastoconidia of L. elongisporus (Gram stain, x 1,000). (F) The patient's disease development process.
case_images: fpubh-11-1181377-g0001.jpg
case_images: PMC10624219_01_fpubh-11-1181377-g0001.jpg
case_images: F1
case_images: CrAg lateral flow assay, T-SPOT TB, and parasite and tumor marker tests were negative. No other primary immunodeficiency diseases, human immunodeficiency virus infection, or antibody spectrum of autoimmune diseases was detected. Transthoracic echocardiography showed a vegetation lesion adherent to the patient's anterior mitral leaflet, which was concerning for infectious endocarditis (Day 3) (Figure 1A). Chest computed tomography (CT) revealed left atrial enlargement. Five days into the patient's hospital stay, her blood was positive for fungal culture (Day 5) (Figures 1B-E). Using whole-genome sequencing, the organism was identified as Lodderomyces elongisporus (L. elongisporus) (Supplemental Figure 1) from the blood. After discharge from the hospital (Day 73), the patient received fluconazole for sequential antifungal therapy for the duration of the study (Figure 1F).