Valvular vegetations in fungal endocarditis frequently embolize to end–organs. However, an embolus large enough to occlude the aorta is rare. There are case reports of aortic thrombosis/embolism with Aspergillus species but very few with Candida species. In this report, we describe a case of multiple emboli caused by aortic valve candidiasis in an immunocompetent patient with sudden-onset paraplegia. 

A 65 year-old male with past medical history of a colonic polyp leading to sigmoid resection complicated by left lower quadrant abscess with colo-cutaneous fistula growing Candida tropicalis presented with sudden onset of bilateral leg pain and paraplegia. On evaluation, both lower limbs were pulseless and profoundly weak. Computed tomography (CT) of the head showed scattered subarachnoid hemorrhage along with acute infarcts in the right posterior cerebral artery and posterior inferior cerebellar artery territories. Head and neck CT angiography demonstrated multiple arterial occlusions, but no aneurysms. MRI holospine was performed and results excluded spinal cord infarct and any epidural cord compression. Abdominal CT angiogram revealed complete occlusion of the infra-renal abdominal aorta along with splenic and bilateral renal infarcts. The patient underwent endovascular thrombo-embolectomy of bilateral aortoiliac vessels. A large amount of organized, thrombotic material was obtained and sent for pathological examination. Echocardiogram showed a peanut sized vegetation on the aortic valve. Blood and urine cultures grew Candida tropicalis and microscopy of the thrombus revealed abundant yeast and pseudohyphal forms.