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Aspergillus pericarditis with tamponade: report of a successfully treated case and review
V Le Moing1, O Lortholary, J F Timsit
1Department of Internal Medicine, Hôpital Avicenne, Université Paris-Nord, Bobigny, France.
Abstract:
We report a case of aspergillus pericarditis with tamponade complicating invasive pulmonary aspergillosis in a patient treated for acute lymphocytic leukemia. Prolonged antifungal therapy and aggressive surgical treatment cured the pericarditis, without relapse, despite the fact that the patient underwent autologous bone marrow transplantation. In a review of 28 other cases of aspergillus pericarditis, we found that this condition usually had occurred in severely immunocompromised patients and was always the result of contiguous dissemination of Aspergillus from the lung or myocardium. Tamponade was present in eight of 29 patients. Aspergillus antigen was detected in the pericardial fluid of all three patients whose fluid specimens were tested. Aspergillus pericarditis was diagnosed before death in 10 of 29 patients, all of whom had established premortem diagnoses of invasive aspergillosis at other sites and had received antifungal therapy. Three of the four survivors received combined medical and aggressive surgical therapies. The performance of echocardiography early during the course of invasive pulmonary aspergillosis, together with intensive combined therapies, might lower the high mortality associated with aspergillus pericarditis.
Insights
Aspergillus pericarditis, a serious complication of invasive pulmonary aspergillosis in immunocompromised patients, can be treated effectively. Early diagnosis and combined antifungal and surgical therapies improve survival rates for this rare condition.
Area of Science:
- Infectious Diseases
- Cardiology
- Hematology
Background:
- Invasive pulmonary aspergillosis is a severe infection in immunocompromised individuals.
- Aspergillus pericarditis is a rare but life-threatening complication.
- Patients with acute lymphocytic leukemia undergoing treatment are at high risk.
Observation:
- A case of Aspergillus pericarditis with tamponade complicating invasive pulmonary aspergillosis is presented.
- The condition typically arises from contiguous spread of Aspergillus from the lungs or myocardium.
- Tamponade was observed in 8 of 29 reviewed cases.
Findings:
- Prolonged antifungal therapy and aggressive surgery successfully treated the pericarditis in the reported case.
- Aspergillus antigen was detected in pericardial fluid, aiding diagnosis.
- Early diagnosis of Aspergillus pericarditis was achieved in 10 of 29 patients, all receiving antifungal therapy.
Implications:
- Combined medical and aggressive surgical therapies are crucial for survival.
- Early echocardiography in invasive pulmonary aspergillosis may improve outcomes.
- Intensive combined therapies could reduce the high mortality associated with Aspergillus pericarditis.