Claviform aspergillus‐related vegetation in the left ventricle of a patient with systemic lupus erythematosus

Abstract

A 38-year-old woman was diagnosed with systemic lupus erythematosus and received immunosuppressive therapy. After 6 months of treatment, workup for low-grade fever yielded elevated enzyme-linked immunosorbent assay titers for Aspergillus antigen in serum and ascites, leading to the diagnosis of disseminated aspergillosis. Transthoracic echocardiography revealed a claviform vegetation attached to the left ventricular anterior septum. Two days after the start of antifungal Amphotericin-B therapy, the patient suffered from several neurologic disorders. A second transthoracic echocardiography revealed that the vegetation decreased in size. Two weeks later, the vegetation increased again. Combination therapy of Amphotericin-B and Voriconazole was initiated, and the vegetation eventually disappeared completely. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:231-232, 2018.

Native-Valve Aspergillus Endocarditis: Case Report and Literature Review

“…galactomannan has been tested in twentyfour cases; it was positive in sixteen cases (66%), five of whom had high serum levels of 1,3-B-d-glucan. Detection of antigenemia informed clinical choices in five cases of immunocompromised hosts with no other microbiological findings and three of them survived, confirming the reliable sensitivity of these markers in the diagnosis of IA in the context of immunosuppression [32,41,55,71,72].…”

A Case of Catastrophic Aspergillus Endocarditis

“…3,7 In our review of current literature, only four patients with Aspergillus endocarditis have survived without surgical intervention, and three of them were infants or children. [12][13][14][15] Higher mortality rates exist for immunosuppressed patients and for patients with mitral valve involvement. 2 However, it was important to remember that like our patient, many patients initially are not surgical candidates and medical treatment in the form of antifungal therapy is the only option.…”

Aspergillus endocarditis of the mitral valve with ventricular myocardial invasion, cerebral vasculitis, and intracranial mycotic aneurysm formation in a patient with hemophagocytic lymphohistiocytosis

“…There are few reported cases of fungal myocardial invasion in patients with hematological malignancies [10] , [11] , allogeneic hematopoietic stem cell and bone marrow transplants [3] , [12] , or with immune dysfunction [13] . Myocardial invasion with invasive aspergillosis in immunocompetent patients has also been described [14] .…”