• Haixia Xu, Hang Zhang, Jiacheng Wu, and Libo Jin.
• Department of Cardiovascular Surgery, Shaoxing People's Hospital, Shaoxing, Zhejiang Province, China.
• Medicine (Baltimore). 2024 Dec 13; 103 (50): e40962e40962.

RationaleFungal endocarditis (FE) is a rare form of infective endocarditis. Compared to bacterial endocarditis, FE develops more slowly and insidiously, with nonspecific clinical manifestations, making diagnosis more challenging. Cases presenting with low back pain as the initial symptom are exceedingly rare, leading to a high risk of misdiagnosis or delayed diagnosis.Patient ConcernsA 61-year-old male was admitted due to recurrent low back pain accompanied by fever for 2 months. He had no history of invasive procedures or immunosuppressive therapy.DiagnosesThe patient was diagnosed with FE.InterventionsThe patient underwent surgical treatment, during which the excrescence was removed, and mitral valve replacement was performed. Postoperatively, he received a full course of antifungal therapy.OutcomesPostoperatively, the patient experienced relief from low back pain and was afebrile. He was discharged after completing antifungal treatment and, upon follow-up after 1 year, had no recurrence of low back pain.LessonsIn this case, the patient initially presented with low back pain, which, despite the presence of fever and other signs of infection, did not readily suggest a cardiac etiology. This case highlights the importance of not being misled by superficial symptoms and underscores the need for comprehensive and accurate physical examinations and targeted investigations for proper diagnosis.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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