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Post-COVID-19 fatal Aspergillus endocarditis: A case report
Narges Najafi1, Azam Moslemi2, Rahman Ghafari3
1Department of Infectious Diseases, Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Ghaemshahr, Iran.
Background:
Aspergillus endocarditis (AE) is a rare fatal infection. The infection is often reported in patients with prosthetic heart valves, immunosuppressed, broad-spectrum antimicrobial use regimens, and drug abusers.
Methods:
Herein, we report a rare case of native mitral valve AE in a 63-year-old man, with a probable COVID-19-associated invasive pulmonary aspergillosis nine months ago treated with antifungals.
Results:
In the last admission, the lethargy, neurological deficit, and septic-embolic brain abscess in brain MRI led to suspicion of infective endocarditis. Transesophageal two-dimensional echocardiography and color Doppler flow velocity mapping showed a large highly mobile mass destroying leaflet and severe mitral regurgitation. The Surgical valve replacement is performed. The surgical valve replacement is performed. Direct microscopic examination and culture of the explanted and vegetative mass revealed Aspergillus section Fumiagati confirmed by molecular method. Despite the administration of voriconazole and transient improvement the patient expired.
Conclusion:
As AE is a late consequence of COVID-19-associated invasive pulmonary aspergillosis, therefore, long-term follow-up of invasive aspergillosis, and prompt diagnosis of surgical and systemic antifungal therapy treatment, are warranted to provide robust management.
Insights
This case report details Aspergillus endocarditis (AE) in a patient with a history of COVID-19-associated invasive pulmonary aspergillosis. Prompt diagnosis and treatment are crucial for managing this rare but fatal infection.
Area of Science:
- Cardiology
- Infectious Diseases
- Mycology
Background:
- Aspergillus endocarditis (AE) is a rare and often fatal infection.
- AE commonly affects patients with prosthetic heart valves, immunosuppression, or those using broad-spectrum antimicrobials.
Observation:
- A 63-year-old man presented with symptoms suggestive of infective endocarditis, including neurological deficits and a brain abscess.
- Imaging revealed a large, mobile mass on the native mitral valve, causing severe regurgitation.
Findings:
- Microscopic examination and molecular methods confirmed Aspergillus section Fumiagati as the causative agent of endocarditis.
- Despite antifungal treatment with voriconazole and surgical valve replacement, the patient's condition deteriorated, leading to expiration.
Implications:
- This case highlights AE as a potential late complication of invasive pulmonary aspergillosis, particularly post-COVID-19.
- Long-term surveillance for invasive aspergillosis and timely diagnosis and treatment of AE are essential for improved patient outcomes.
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