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

Abstract

Aspergillus endocarditis is a rare infection and reported mainly in immunocompromised hosts. We report a case of mitral valve aspergillus endocarditis with ventricular myocardial invasion, cerebral vasculitis and intracranial fungal aneurysm formation in a patient with hemophagocytic lymphohistiocytosis (HLH). This case illustrates the importance of prompt investigation and treatment of masses seen on an echocardiogram for rare infections such as Aspergillus endocarditis in immunocompromised patients.

Difficulty of diagnosing a mucor-induced aneurysm arising in segment P4 of the posterior cerebral artery – A case report

“…e sensitivity of such antigen testing was reported to range from 83 to 100% and its specificity was reported to range from 86 to 97.5%. [19] However, no Mucor antigen tests are currently available, and hence, a histopathological examination is needed if culture tests show no fungi or bacteria.…”

Delayed development of a de novo contralateral middle cerebral artery aneurysm in a patient with hyperimmunoglobulin E syndrome: A case report

“…Immunocompromised patients, such as those with HIES, are predisposed to systemic and local recurrent bacterial and fungal infections, which may be chronic or recurrent. [8][9][10][11] Chronic infection results in a systemic inflammatory state that may weaken vascular walls by degrading the endothelium, thereby inducing aneurysm development. 12 Previous work by Freeman et al found focal cerebral hyperintense lesions via MRI in 35/50 (70%) studied HIES patients, potentially representing manifestations of small vessel degeneration that are more typically found in the elderly.…”

“…25 Lastly, various opportunistic infections, including S. aureus infection, have been associated with aneurysms attributed to vascular abnormalities. [8][9][10][11][12]26 Each of these factors could have contributed, independently or additively, to the etiology of this patient's second, de novo, contralateral MCA aneurysm and SAH.…”

Spectrum of Large- and Medium-Vessel Vasculitis in Adults: Neoplastic, Infectious, Drug-Induced, Autoinflammatory, and Primary Immunodeficiency Diseases

“…is the most frequent fungus associated with vasculitis. Cerebral MVV is the most common vasculitis; however, large vessels like the distal carotids or aorta can be affected as well [ 105 , 106 •, 131 – 135 ].…”

“…Candida and Aspergillus spp. [ 105 , 134 , 135 ] Parasites (iii) Taenia solium (neurocysticercosis) Migration from endemic region (seroprevalence in endemic regions is very high) + / − ICA [ 136 ] ‡ cerebral (“cysticercal arteritis”) [ 136 ] Toxocara spp. Close contact to dogs/cats (ownership); migration from and travel to endemic regions (ii) ‡ cerebral (all vessels can be affected) [ 137 ] (i) Main vessels or vessel beds identified by our literature search (i.e., arteries or vessel beds not listed, could still be affected).…”