Aspergillus fumigatus pericarditis: A rare case in a lupus patient

Pericardial aspergillosis is a rare but potentially fatal opportunistic infection primarily affecting immunocompromised patients. Diagnosis is challenging due to nonspecific clinical manifestations and difficulties in obtaining definitive microbiological confirmation. Risk factors include immunosuppressive therapies, hematologic malignancies, and solid organ transplantation. While pulmonary involvement is most common, cardiac manifestations such as pericarditis are infrequent and often diagnosed post-mortem. We report a case of Aspergillus fumigatus pericarditis in a 45-year-old female with systemic lupus erythematosus on corticosteroids, presenting with dyspnea, hypotension, and pancytopenia. Diagnostic work-up revealed a large pericardial effusion with subsequent identification of Aspergillus fumigatus in pericardial fluid cultures despite initial negative results. Prompt initiation of empirical antifungal therapy led to clinical improvement, underscoring the importance of early recognition and aggressive management in similar cases. This case highlights the complexities of managing fungal pericarditis and underscores the need for heightened clinical suspicion and tailored therapeutic approaches in immunocompromised patients.