ENDOCARDITIS CAUSED BY PURPUREOCILLIUM LILACINUM: AN UNCOMMON ETIOLOGY

Cases of rare invasive fungal diseases have increased worldwide, reflecting the growing complexity of immunocompromised patients and interaction with environmental factors. Purpureocillium lilacinum is a filamentous, hyaline, saprophytic fungus found in soil and decomposing organic matter. It is recognized as an emerging opportunistic pathogen, particularly in immunocompromised individuals, where it can cause a spectrum of infections collectively termed hyalohyphomycoses, but reports of invasive human infection remain scarce. A 59-year-old man from Mossoró-RN, living in São Paulo-SP, a forklift operator in a warehouse, with progressive symptoms of heart failure in the six months prior to admission. He had Parkinson’s disease as a comorbidity. He was admitted to the emergency department with dyspnea at rest, cold extremities and signs of hypoperfusion, classified syndromically as heart failure profile C requiring vasopressors and with second-degree atrioventricular block (2:1). Transesophageal echocardiography revealed an aortic valve vegetation (10 × 3 mm) and a paravalvular abscess (26 × 10 mm). He underwent surgical valve replacement, with Purpureocillium lilacinum isolated in culture from intraoperative material and in one blood culture. He was treated with voriconazole for 12 weeks, with complete resolution of the paravalvular abscess, clearance of blood cultures and significant clinical recovery. This case highlights the importance of recognizing rare fungal agents as possible causes of infectious endocarditis, particularly in patients with occupational exposure to environments favorable to the presence of these microorganisms. Purpureocillium lilacinum is frequently found in soils, plants and organic waste and may act as an opportunistic pathogen in patients with immunologic compromise, which was not identified in this case. Infection by Purpureocillium lilacinum is rare but should be considered in the differential diagnosis of fungal endocarditis. An integrated approach between human, environmental and occupational health is essential to understand and prevent infections by emerging environmental pathogens.