A 48-year-old woman was admitted to our centre with symptoms of right heart failure. Pulmonary arterial hypertension (PAH) was diagnosed. The patient’s general condition deteriorated despite initiation of sequential PAH specific therapy and hemodynamic support. Coexisting fungal mural endocarditis led to devastating consequences. Infection presented in a deceptive manner. The patient was afebrile, inflammatory markers were low, blood cultures were negative for bacteria, echocardiography revealed only an increased trabeculation of the right ventricle. The authors discuss management of decompensated right ventricular failure secondary to chronic pulmonary hypertension. The literature on fungal mural endocarditis is also reviewed. JRCD 2013; 1 (2): 69–74