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Published on: May 17, 2015
Case report: Vascular graft infection due to Aspergillus species presenting with recurrent vascular occlusion
Ayami Tano1, Koichi Kato2, Yoshimasa Seike3
1Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan.
Background:
An aortic graft implantation is an effective therapeutic method for various aortic diseases. However, it is known that sometimes these implanted grafts can be the foci of infections. Here we report a rare case of graft infection that presented multiple embolisms of aortic branches and peripheral organs.
Case Presentation:
A 63-year-old Japanese woman with a history of aortic graft implantation presented with occlusions of large arteries in different loci and time points, with elevation of non-specific inflammatory markers. Thoracic contrast-computed tomography (CT) captured vegetation in the descending aortic graft and the [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) showed accumulation of FDG in the same site, suggesting a graft infection. Despite all these suspicious findings, repeated blood culture examinations never detected any microorganisms. A diagnosis of Aspergillus graft infection was made based on an elevated serum β-D glucan (βDG) and a positive Aspergillus galactomannan (GM) antigen test. The patient subsequently had surgery with replacement of the descending aortic graft and anti-fungal drugs were instituted with significant improvement noted.
Conclusion:
In the present case, the patient's specific feature in the anatomical vascular construction, past operation, and basal fundamental diseases collaboratively contributed to the pathogenesis of the present infection. It is important to recognize the risk of graft infection and conduct imaging studies when indicative symptoms emerge. The negativity in blood culture studies often makes detection of pathogenic microbes extremely difficult. This case suggests that non-cultural tests such as bDG and GM can be useful for diagnosis and starting appropriate anti-fungal drugs in the early stages.
Insights
This case highlights a rare aortic graft infection presenting as multiple embolisms. Non-cultural tests like beta-D glucan and Aspergillus galactomannan antigen tests aided diagnosis when blood cultures were negative.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Medical Imaging
Background:
- Aortic graft implantation is a vital treatment for aortic diseases.
- Implanted aortic grafts can become sites of infection.
- Graft infections may lead to serious complications like embolisms.
Observation:
- A 63-year-old woman with a history of aortic graft implantation presented with multiple arterial occlusions.
- Imaging revealed vegetation on the aortic graft, suggestive of infection.
- Blood cultures were repeatedly negative for microorganisms.
Findings:
- Diagnosis of Aspergillus graft infection was confirmed via elevated serum beta-D glucan (βDG) and positive Aspergillus galactomannan (GM) antigen test.
- Surgical replacement of the aortic graft and antifungal therapy led to significant patient improvement.
Implications:
- This case underscores the importance of considering graft infection in patients with relevant history and symptoms.
- Non-cultural diagnostic methods (βDG, GM tests) are crucial when blood cultures are negative.
- Early diagnosis and treatment of aortic graft infections are critical for patient outcomes.
