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Polymicrobial endocarditis is a well-recognized problem in intravenous drug users and it accounts for 1 to 3% of endocarditis cases overall and up to 9% in other series. The most common combinations of organisms include  Staphylococcus aureus  and  Streptococcus pneumoniae  followed by  Staphylococcus aureus  and  Pseudomonas aeruginosa .  Candida parapsilosis  endocarditis carries a mortality rate of 45%, and each infection with  Candida  or  Pseudomonas  endocarditis per se carries a very high mortality rate approaching 85% and 80%, respectively. The combination of  P. aeruginosa  and  C. parapsilosis  has never been encountered and there have been no earlier reports of the combination of  C. parapsilosis  and  P. aeruginosa  in adult intravenous drug users as a cause of endocarditis.    Case presentation  We present a 49-year-old man with bivalvular endocarditis with  P. aeruginosa  and  C. parapsilosis . He had a prior bivalvular replacement in 2005 that became infected with the above microorganisms and he was treated with intravenous antibiotics. Because of ongoing intravenous drug use, a second valve replacement was denied. A few days later, the patient presented with septic shock secondary to  P. aeruginosa  and  C. parapsilosis  recurrent endocarditis. The infection was cured with a second bivalvular replacement and extended therapy with antibiotics and antifungals.    Conclusion  This is the first time a patient has presented with  P. aeruginosa  and  C. parapsilosis endocarditis . Relapsing polymicrobial endocarditis can be cured with medical and surgical therapy.

journal of medical case reports

Successful treatment of Candida parapsilosis and Pseudomonas aeruginosa infection using medical and surgical management in an injecting drug user with mitral and aortic valve endocarditis: a case report