Recurrent Aspergillus endocarditis in an immunocompetent patient: challenges in diagnosis and management
DOI:
https://doi.org/10.2218/resmedica.v24i1.1567Keywords:
Infective endocarditis, Aspergillus, Cardiology, Cardiovascular disease, InfectionAbstract
We describe an unusual case of recurrent Aspergillus endocarditis in an immunocompetent 64-year-old lady. Four weeks after aortic valve replacement surgery, she presented with an inferior ST elevation myocardial infarction. Coronary angiography demonstrated compromise of the ostium of the right coronary artery, which was successfully treated by primary angioplasty and stenting. Six weeks later, she suffered from a subarachnoid haemorrhage secondary to a mycotic aneurysm. A transoesphageal echocardiogram suggested a large aortic root vegetation. She underwent urgent aortic root replacement with removal of the vegetation, which was subsequently confirmed to be caused by Aspergillus. She was discharged on long term anti-fungal medication (Voriconazole), which she discontinued after seventeen weeks. Several years later, she presented with non-specific symptoms and was ultimately diagnosed with a recurrence of Aspergillus endocarditis. This case illustrates one of the many non-specific ways Aspergillus endocarditis can present. A high index of suspicion can prevent significant life-threatening complications.
References
Tattevin P, Revest M, Lefort A, Michelet C, Lortholary O. Fungal endocarditis: current challenges. International Journal of Antimicrobial Agents. 2014;44(4):290-294. Available from: http://www.sciencedirect.com/science/article/pii/S0924857914002349 [Accessed 21 July 2016]
Bapat V, Young C. Aspergillus endocarditis Presenting as Massive Peripheral Embolism Following Open Heart Surgery. EJVES Extra. 2005;10(1):27-29. Available from: http://www.sciencedirect.com/science/article/pii/S1533316705000579 [Accessed 21 July 2016]
Gould F, Denning D, Elliott T, Foweraker J, Perry J, Prendergast B et al. Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy. Journal of Antimicrobial Chemotherapy. 2011;67(2):269-289. Available from: http://jac.oxfordjournals.org/content/early/2011/12/02/jac.dkr450.full [Accessed 21 July 2016]
Habib G, Lancellotti P, Antunes M, Bongiorni M, Casalta J, Del Zotti F et al. 2015 ESC Guidelines for the management of infective endocarditis. European Heart Journal. 2015;36(44):3075-3128. Available from: http://dx.doi.org/10.1093/eurheartj/ehv319 [Accessed 22 July 2016]
Kalokhe A, Rouphael N, El Chami M, Workowski K, Ganesh G, Jacob J. Aspergillus endocarditis: a review of the literature. International Journal of Infectious Diseases. 2010;14(12):e1040-e1047. Available from: http://www.sciencedirect.com/science/article/pii/S1201971210024963 [Accessed 21 July 2016]
Hussein N, Qamar S, Abid Q. Systemic aspergilloma post aortic root surgery following coronary artery stenting: diagnostic and management dilemma. BMJ Case Reports. 2015;2015. Available from: http://casereports.bmj.com/content/2015/bcr-2014-207702.abstract [Accessed 22 July 2016]
Downloads
Published
Issue
Section
License
This is an Open Access journal. All material is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) licence, unless otherwise stated.
Please read our Open Access, Copyright and Permissions policies for more information.