Endocarditis caused by Coccidioides species has been reported rarely. Herein, we report 2 such cases and summarize 4 published reports. Coccidioidal endocarditis was found in patients who had prolonged or disseminated infection. Vegetations were identified on mitral or aortic valves or valvular rings, and embolic phenomena were observed. Diagnosis was hindered by uniformly negative results from blood cultures. The patients had a wide range of serologic titers for Coccidioides species (1:1-1:2048). The infection was fatal in 4 of the 6 patients whose cases we reviewed. We conclude that coccidioidal endocarditis is an uncommon manifestation of Coccidioides infection that connotes a poor prognosis.
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