Kodamaea ohmeri–associated mitral valve endocarditis complicated by septic embolism of the right femoral artery: A case report

Invasive fungal endocarditis is a rare but highly lethal infection, and diagnostic accuracy is often hindered by misidentification of uncommon yeasts. Kodamaea ohmeri, in particular, is frequently mistaken for Candida species by conventional microbiological methods, leading to delays in definitive diagnosis and appropriate therapy. We report a 58-year-old male with a history of intravenous drug use who presented with acute right lower limb ischemia from femoral artery thrombosis. Despite emergent thrombectomy, persistent fever developed, and blood cultures yielded yeast that was ultimately identified as K. ohmeri by internal transcribed spacer and 26S rRNA gene sequencing. Transthoracic echocardiography revealed a large mitral valve vegetation, and fungal elements were identified within the arterial thrombus. Antifungal therapy with amphotericin B, followed by a liposomal formulation, successfully cleared fungemia. Severe valvular destruction necessitated mitral valve replacement, and molecular testing of excised tissue confirmed K. ohmeri infection. The patient completed prolonged antifungal therapy with oral voriconazole suppression and remained recurrence-free at 2-year follow-up. This case underscores the diagnostic challenges posed by rare yeasts and highlights the importance of early molecular identification, targeted antifungal therapy, and timely surgical intervention to optimize outcomes in K. ohmeri endocarditis.