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Case Reports
. 2026 Apr;42(4):526-529.
doi: 10.1007/s12055-025-02095-3. Epub 2025 Dec 3.

Prosthetic valve endocarditis caused by a very rare black mold, Exophiala dermatitidis

Debashish Panigrahi  1 , Adarsh Subrahmanyam Koppula  2 , Nukala Mallikarjuna Rao  1 , Prem Prakash  1 , Sumedha Mukherjee  1 , Ratna Malika Kumar  2 , Shobhit Saurav  1 , Rajneesh Malhotra  2
Affiliations
Case Reports

Prosthetic valve endocarditis caused by a very rare black mold, Exophiala dermatitidis

Debashish Panigrahi et al. Indian J Thorac Cardiovasc Surg. 2026 Apr.

Abstract

Prosthetic valve endocarditis (PVE) caused by Exophiala dermatitidis is an exceedingly rare and diagnostically challenging condition. We present the case of a 62-year-old male who developed fungal PVE 18 months post-aortic valve replacement (AVR) with a bioprosthetic valve. The patient exhibited persistent low-grade fever and dyspnea, with transesophageal echocardiography (TEE) revealing large vegetations and an aortic annular abscess. Despite sterile blood cultures, intraoperative findings of black, friable vegetations prompted empirical antifungal therapy. Nanopore sequencing rapidly identified Exophiala dermatitidis, facilitating targeted dual antifungal treatment with voriconazole and liposomal amphotericin B. This case highlights the importance of early surgical intervention, molecular diagnostics, and combination antifungal therapy in managing fungal PVE caused by E. dermatitidis, emphasizing the need for heightened clinical suspicion and multidisciplinary approaches for improved patient outcomes.

Keywords: Black fungus; Black mold; Exophiala dermatitidis; Fungal prosthetic valve endocarditis.

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Conflict of interest statement

Conflict of interestThe authors have no conflicts of interest to declare.

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