Title : A rare case of aortic aspergillosis in an immunocompetent patient with no pre-existing cardiac pathology – A case report
Abstract:
Background: Cardiac aspergillosis is a rare form of Invasive Aspergillus infection that carries high mortality despite aggressive treatment. It usually occurs in patients with underlying cardiac abnormalities such as cardiac lesions, prosthetic valves, cardiac devices, and heart transplants.
Case Summary: A 30-year-old male with right-sided body numbness had a CT Head revealing a suspected neurocysticercosis lesion. Initial labs showed mildly elevated CRP and normal procalcitonin. Echocardiogram found a mass on the aortic valve and a thick left atrial wall. PET CT revealed a hypermetabolic mass around the heart and aortic root. IgG4 levels were high and tissue biopsy was needed for confirmation. However, the patient developed bilateral lower limb ischemia and weakness, requiring emergency surgeries. The biopsy showed invasive aspergillosis, treated with Amphotericin B. Unfortunately, the patient deteriorated into septic shock despite treatment.
Discussion: This clinical case accentuates several challenges encountered in the management of aortic aspergillosis in a patient with a low suspicion of invasive aspergillosis. Firstly, it emphasizes the importance of considering the rare possibility of invasive aspergillosis in immunocompetent patients, even with no known risk factors. Secondly, it brings out the recognition of the rapid progression of Aspergillosis endocarditis with poor outcomes. Finally, it emphasizes that early surgical treatment and early histological diagnosis with early initiation of antifungals can save lives.
