Despite diagnostic and therapeutic advances in medical, surgical, and critical care, the mortality rate for Aspergillus endocarditis remains dismal (approaching 100%). We report a case of a 49 year old immunocompetent woman with recent aortic valve prosthesis who presents with fever, chills, sweats, left facial droop, left arm weakness, petechial rash and cyanotic toes. Initial trans-esophageal echo was normal but a repeat study revealed a 9 × 5 mm vegetation abutting the aortic pros- thesis. Microbiological correlation could not be documented despite the presence of persistent fever through serial blood cultures, and the diagnosis of Aspergillus fumigatus endocarditis was ultimately made on embolectomy specimen when she developed an ischemic right leg. Aggressive medical treatment was initiated with intravenous voraconazole, liposomal amphotericin-B and heparin. The timing of surgical intervention was contemplated, but was precluded by multiple comorbidities. She succumbed to her illness after developing cerebral herniation following intraparenchymal hemorrhage.
The effectiveness of combined medical intervention and surgical valve replacement for Aspergillus endocarditis is therefore contingent on high diagnostic suspicion and early echocardiographic detection in a high risk individual with features of culture-negative endocarditis.
PDF (867.24 KB PDF FORMAT)
RIS citation (ENDNOTE, REFERENCE MANAGER, PROCITE, REFWORKS)
BibTex citation (BIBDESK, LATEX)
My co-authors and I had a very positive experience with the review and publication process in Clinical Medicine Insights: Cardiology. The review was on point, and publication was also rapid and allowed us the needed revisions in the proof preparation process.
All authors are surveyed after their articles are published. Authors are asked to rate their experience in a variety of areas, and their responses help us to monitor our performance. Presented here are their responses in some key areas. No 'poor' or 'very poor' responses were received; these are represented in the 'other' category.See Our Results
Copyright © 2014 Libertas Academica Ltd (except open access articles and accompanying metadata and supplementary files.)