Aspergillus pericarditis: clinical and pathologic features in the immunocompromised patient

Area of Science:

• Medical Mycology
• Infectious Diseases
• Cardiology

Background:

• Infectious complications from Aspergillus are increasing in cancer and transplant patients.
• Aspergillus pericarditis is a rare but severe manifestation.
• This study examines clinical and pathological findings of this infection.

Purpose of the Study:

• To describe the clinical and pathological features of Aspergillus pericarditis.
• To highlight the diagnostic challenges and outcomes.
• To emphasize the importance of considering this diagnosis in at-risk patients.

Main Methods:

• Retrospective analysis of six immunocompromised patients with Aspergillus pericarditis at autopsy.
• Review of clinical records, imaging, and postmortem pathological findings.
• Correlation of pulmonary and pericardial Aspergillus involvement.

Main Results:

• All six patients had pulmonary aspergillosis; two developed fatal cardiac tamponade.
• Pericardial involvement was extensive, with large effusions and myocardial abscess rupture.
• Diagnosis was not established antemortem; imaging findings were nonspecific.
• Aspergillus invaded the pericardium from contiguous pulmonary foci or myocardial abscesses.

Conclusions:

• Aspergillus pericarditis is a lethal cardiac infection with increasing frequency.
• It should be considered in immunocompromised patients with hemodynamic instability, especially with pericarditis or pulmonary aspergillosis.
• Prompt recognition and treatment are critical for improved outcomes.