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Aspergillus mediastinitis after cardiac surgery.
Marie-Josée Caballero1, Nicolas Mongardon1, Hakim Haouache1
1Université Paris Est, Faculté de Médecine, Créteil, France; Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
Summary
A rare fungal infection, Aspergillus mediastinitis, can occur after heart surgery. Prompt surgical drainage and antifungal treatments, including voriconazole, led to a full recovery in a challenging case.
Area of Science:
- Cardiology
- Infectious Diseases
- Mycology
Background:
- Mediastinitis is a severe post-cardiac surgery complication, with bacterial infections being common and fungal infections, particularly Aspergillus, being rare and often fatal.
- Postoperative Aspergillus mediastinitis presents a significant challenge due to its rarity and typically poor prognosis.
Observation:
- A case study details a 42-year-old patient who developed Aspergillus fumigatus mediastinitis following cardiac surgery.
- Key risk factors identified included cardiogenic shock necessitating veno-arterial extracorporeal life support and sternal wound closure failure.
Findings:
- The patient achieved a complete recovery through surgical debridement, antifungal therapy (liposomal amphotericin B, followed by voriconazole and caspofungin), with no relapse over 18 months.
- Literature review indicates that postoperative Aspergillus mediastinitis can be paucisymptomatic, necessitating a high index of suspicion for culture-negative or indolent infections.
Implications:
- This case highlights the possibility of favorable outcomes in Aspergillus mediastinitis with aggressive management.
- Effective antifungal strategies should incorporate amphotericin B or voriconazole alongside surgical intervention.
- Early recognition and treatment are crucial for improving patient survival and recovery from this rare but serious complication.
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