Abstract
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.
Highlights
Fungal endocarditis is uncommon, representing less than 2% of all cases of endocarditis
TREATMENT She was initially treated empirically for urinary sepsis with intravenous (IV) amoxicillin plus gentamicin. This regimen was changed to IV piperacillin/tazobactam and oral co-amoxiclav after microbiology report isolated E. coli sensitive to piperacillin/tazobactam from her urine
She was offered further surgery to resect the large aortic vegetation, both the patient and her family were reluctant to consider a third major cardiac operation. Her temperature and inflammatory markers settled, and she was discharged to supported accommodation on long-term oral voriconazole. This case demonstrates a case of fungal endocarditis that led to a series of complications in a nonimmunocompromised patient
Summary
Fungal endocarditis is uncommon, representing less than 2% of all cases of endocarditis. Of this 2%, only 20–25% are represented by Aspergillus.[1] It usually affects patients who are immunocompromised.[1] Cardiac fungal infections carry a high mortality. Patients with Aspergillus endocarditis are usually recommended to have surgical resection and continue on long-term anti-fungal therapy.[3]
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