Aspergillus endocarditis in lung transplant recipients: case report and literature review

Area of Science:

• Infectious Diseases
• Cardiology
• Transplantation Medicine

Background:

• Fungal endocarditis is a rare but life-threatening complication, especially in immunocompromised patients.
• Lung transplantation (LT) recipients are at increased risk for invasive fungal infections.
• Aspergillus fumigatus is a common pathogen in post-transplant settings.

Observation:

• This review details a case of Aspergillus endocarditis in an LT patient and analyzes 6 prior cases.
• All identified cases involved Aspergillus fumigatus, with most patients transplanted for cystic fibrosis.
• Peripheral emboli were common (85%), while blood cultures were consistently negative.

Findings:

• Diagnosis was often delayed, occurring 8±6 months post-LT.
• Transthoracic echocardiography had limited sensitivity for detecting vegetations, which were large (>1.5 cm) when present.
• Mortality was high (71%), with disseminated disease being the primary cause of death.

Implications:

• Aspergillus endocarditis requires a high index of suspicion in lung transplant recipients presenting with embolic events.
• Combined antifungal therapy and surgical intervention are crucial for patient survival.
• Further research into diagnostic modalities and treatment strategies for this rare condition is warranted.