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Aspergillus mural endocarditis presenting with multiple cerebral abscesses
Andrew A Pavlina1, Jared W Peacock2, Saad A Ranginwala1
1University of Cincinnati Department of Radiology, 234 Goodman Street, Cincinnati, OH, 45267, USA.
Background:
Fungal endocarditis is a rare and lethal cardiac infection which most commonly presents in immunocompromised patients or patients with other predisposing conditions. In a small subset of these patients, lesions present as mural masses and do not have any involvement with native valves or implanted devices. Here we present one such case which was diagnosed in the antemortem period in time to be managed with surgical resection.
Case Presentation:
A 70 year-old female patient who presented with multiple cerebral abscesses and was found on echocardiography to have a mass along the inferior wall of the left ventricle. She underwent surgical resection which revealed an Aspergillus vegetation along the left ventricle wall without any involvement of the cardiac valves. An intraoperative photograph was obtained and is presented in this case. The patient was started on antifungal therapy and expired on day 30 of treatment.
Conclusions:
Fungal endocarditis is a rare yet lethal disease. It can be difficult to detect and workup should be initiated immediately if there is any clinical suspicion. This is especially true in any patient with predisposing conditions or any patient who presents with undiagnosed, culture-negative fevers or evidence of embolic foci. Once diagnosis is made, early initiation of antifungal therapy coupled with aggressive surgical debridement is required for any significant chance of survival.
Insights
This case highlights a rare fungal endocarditis presentation as a left ventricular mural mass. Early diagnosis and surgical intervention are crucial for managing this lethal cardiac infection.
Area of Science:
- Cardiology
- Infectious Diseases
- Mycology
Background:
- Fungal endocarditis is a rare, lethal cardiac infection, often affecting immunocompromised individuals.
- A subset of patients present with mural masses unrelated to native valves or devices.
- This case focuses on diagnosing and managing such a rare presentation.
Observation:
- A 70-year-old female presented with cerebral abscesses and a left ventricular (LV) inferior wall mass.
- Echocardiography identified the LV mass.
- Surgical resection revealed an Aspergillus vegetation on the LV wall, without valve involvement.
Findings:
- Surgical findings confirmed Aspergillus vegetation as a mural mass.
- The patient received antifungal therapy post-surgery.
- Despite treatment, the patient expired 30 days post-therapy initiation.
Implications:
- Highlights the importance of considering fungal endocarditis in specific clinical scenarios.
- Emphasizes the need for prompt diagnosis and workup in suspected cases, especially with culture-negative fevers or embolic events.
- Underscores that early antifungal therapy combined with aggressive surgical debridement offers the best chance of survival.
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