Fungal mobile mass on echocardiogram: native mitral valve Aspergillus fumigatus endocarditis

Area of Science:

• Cardiology
• Infectious Diseases
• Mycology

Background:

• Infective endocarditis (IE) is most commonly bacterial, but fungal IE is increasing, particularly in immunocompromised individuals.
• Aspergillus fumigatus is a rare but serious cause of native valve endocarditis.
• Early diagnosis and treatment are crucial for managing fungal IE.

Observation:

• A case of invasive Aspergillus fumigatus native mitral valve endocarditis is presented.
• The patient received empiric antifungal therapy with liposomal amphotericin B and flucytosine.
• Surgical intervention included debridement, valve replacement, and chordae tendineae repair.

Findings:

• Despite standard treatment and documented fungal susceptibility, the patient developed early-onset septic emboli.
• This complication occurred unexpectedly, even after surgical source control.
• The early development of septic emboli challenges current treatment paradigms for Aspergillus endocarditis.

Implications:

• This case underscores the potential for severe complications in Aspergillus endocarditis, even with optimal therapy.
• Further research is needed to understand the mechanisms behind early septic emboli in fungal IE.
• Treatment strategies for Aspergillus endocarditis may require novel approaches to prevent such adverse events.