Aspergillus Pericarditis with Tamponade in a Renal Transplant Patient

Area of Science:

• Infectious Diseases
• Cardiology
• Transplant Medicine

Background:

• Aspergillus pericarditis is a rare, life-threatening infection primarily affecting immunocompromised individuals.
• Nonspecific clinical signs and comorbidities often delay diagnosis, making antemortem identification infrequent.
• A high index of suspicion is vital for timely evaluation and diagnosis in at-risk populations.

Observation:

• A renal transplant recipient with liver cirrhosis presented with decompensated cirrhosis, acute cellular rejection, and polymicrobial bacteremia (Kluyvera, VRE).
• Four months post-transplant, the patient developed lethargy, fluid overload, shock, and respiratory failure.
• Echocardiography revealed pericardial effusion complicated by cardiac tamponade.

Findings:

• Emergent pericardiocentesis yielded purulent fluid, and empiric antibiotics were initiated.
• Mold identified as Aspergillus fumigatus grew from pericardial fluid, prompting Amphotericin B therapy.
• Despite treatment, the patient's condition rapidly deteriorated, leading to expiration.

Implications:

• This case highlights the critical need for heightened clinical suspicion for invasive Aspergillus infections in immunocompromised transplant recipients.
• The nonspecific presentation and complex comorbidities underscore diagnostic challenges.
• Prompt recognition and aggressive management, including antifungal therapy, are essential, though outcomes remain poor in severe cases.