Aspergillus Arterial Emboli in a Patient After Coronary Artery By-Pass Grafting

Abstract

In this report, a 74-year old male with atypical emboli of the aortic and superior mesenteric arteries is presented. In the period preceding the occurrence of emboli, patients complained of malaise, low grade fever and weight loss. Incidentally, the patient underwent coronary artery bypass grafting two years prior to presentation. The pathologic examination of the embolus revealed the presence of typical Aspergillus spp hyphae. The presence of Aspergillus spp antigen in the patient serum was confirmed by an immunoenzymatic test. The transthoracic echocardiography did not show any signs of endocarditis or vegetations on the valves. Transesophageal echocardiography and angio-CT demonstrated lesions consistent with Aspergillus aortitis in the ascending aorta. The basic clinical features of Aspergillus aortitis and aspergillus emboli are discussed in this report. Key words: aortic emboli, Aspergillus aortitis Peripheral arterial emboli are one of the primary causes of acute limb ischemia. Most frequently, the embolic material originates in the heart and is part of the thrombus that developed during either atrial fibrillation or less often myocardial infarction. The cardiac valves or deep venous system, in the case of communications between the right and left part of the heart, could be the source of peripheral embolus. In about 20% of cases, the source of embolus remains undetected.The purpose of this paper was to present the case of double arterial embolism in a patient after coronary artery bypass grafting. CASE REPORTZ.E., a 74-year-old male (medical history number: 02177/05/HCHSZ), was referred to the Department of General and Vascular Surgery in Poznań for severe pain of both lower extremities. The pain appeared suddenly three hours before the patient's presentation to the hospital. Pain in the lower extremities was concomitant with severe abdominal pain. For several months, the patient complained of general malaise, low grade fever and weight loss. His medical history included hypertension and diabetes diagnosed 15 years before, which was treated with insulin at the time of presentation. Seven years earlier, he experienced myocardial infarction and two years prior to hospitalization, he underwent coronary artery bypass grafting. The patient recalled that during his stay in the cardiac surgery department, renovation works were being conducted. Twenty-five years earlier, he was operated on for acute appendicitis. Directly prior to his admission to the Department, the patient was on ticlopidin 2 x 250 mg, metoprolol 1 x 25 mg, atorvastatin 40 mg in the evening and nitroglycerin, when required.On physical examination, the abdomen was not distended, soft, with mild tenderness in the mid-abdomen. No rebound tenderness or pathologic masses were observed. Severe coldness and mottled cyanosis of the lower extremities were observed. Cyanosis extended to the midthigh on the left side and the groin on the right side. The absence of sensation and paralysis of both lower extremities were observed.