Background and aims Despite the application of surgery and antifungal therapy, Candida endocarditis remains a life-threatening infection with significant morbidity and mortality. We report an infant with floconazole-resistant Candida albicans endocarditis who had a congenital heart defect and was treated successfully with caspofungin.

Methods A 13-month-old girl was admitted to our centre with a 3-day history of vomiting, fever and cough. She had a history of pulmonary artery banding for a large ventricular septal defect at 4 months of age. After the operation she had been hospitalised about 3 months in the intensive care unit and had been discharged with tracheostomy and home ventilation due to chronic lung disease. At admission, she had irritability, dyspnea and a severe systolic murmur. Laboratory tests revealed an increase in acute-phase reactants and anaemia. Transthoracic echocardiography showed a vegetation measuring 7 × 10 mm on the wall of right pulmonary artery, just distal to the pulmonary banding region. Blood cultures were obtained and empiric antibiotic treatment with ampicillin/sulbactam and gentamicin was started.

Results C. albicans was isolated from two of her blood culture samples, which was not responsive to one-week course of fluconazole treatment. The isolate was found to be resistant to fluconazole. Patient recovered completely with a six-week course of caspofungin treatment.

Conclusions Physicians should be aware of the possibility of fungal pathogens in endocarditis. Microbiologic diagnosis contributes to successful treatment of Candida endocarditis.