Aspergillus Pericarditis with Tamponade: Report of a Successfully Treated Case and Review

Abstract

and Philippe CasassusWe 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.Invasive aspergillosis (IA) has become a common fungal pergillus and aspergillosis with the terms pericarditis, pericardium, hemopericardium, myocarditis, and pancarditis. We also infection in patients who have profound neutropenia for prolonged periods. The prevalence of IA is estimated to be as high reviewed the published series and reviews on infectious pericarditis and IA in patients with AIDS, chronic granulomatous as 70% among patients who have been granulocytopenic for 1 month [1]. IA is also being observed increasingly in patients disease (CGD), leukemia, lymphoma, and solid organ and bone marrow transplants and in those receiving corticosteroid therwith solid organ transplants, late-stage AIDS, and diabetes mellitus and in those who have received prolonged corticosteroid apy. References cited in the articles reviewed were also scrutinized for potential additional cases. therapy. The most frequent sites of IA are the lungs and nasal sinuses, but dissemination occurs in 20% -30% of immuno-A case could be evaluated when sufficient demographic information was available for the clear identification of an indicompromised patients [2]. Cardiac involvement is uncommon and most often manifests as endocarditis or myocarditis [2]. vidual patient. We considered aspergillus pericarditis to be present in patients who had (1) evidence of clinical and/or Pericardial aspergillosis is rarely diagnosed before death and has been considered always fatal in neutropenic patients [3]. macroscopic involvement of the pericardium during the course of histologically and mycologically confirmed IA, without any We report a case of pericardial aspergillosis with tamponade in which combined antifungal and surgical therapies were sucreported alternative cause of pericarditis; (2) a ...

Myocardial Infarction Caused by Aspergillus Embolization in a Patient with Aplastic Anemia

“…, and Aspergillus pericarditis and myocarditis have also been described in some papers (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). In this report, we describe a case in an aplastic anemia patient with fungal occlusion of the coronary arteries and fungal invasion of the pericardium and myocardium, although he had been receiving treatment with amphotericin B.…”

“…(6)(7)(8)(9)(10), endocarditis (7,(18)(19)(20)(21)(22), pericarditis (7,8,(10)(11)(12)(13)(14)(15)(16)(17), pericardial tamponade (11,13,16), superior vena cava syndrome (23), aortitis (24), intracardiac mass (25) and atrioventricular block (9). (6,11,12,16,27). Treatment has been successful in a few cases (12,16,28), but most patients have died.…”

“…(6,11,12,16,27). Treatment has been successful in a few cases (12,16,28), but most patients have died. Cultures of various specimens, chest X-rays and serological assays are used for diagnosis, but they are often inferior in sensitivity and specificity (29).…”

Acute Lymphocytic Leukemia with Superimposed Invasive Aspergillosis and Pneumopericardium Successfully Treated with Voriconazole

“…In postmortem series, less than 5% of all patients Acute lymphocytic leukemia with superimposed invasive aspergillosis and pneumopericardium successfully treated with voriconazole Carlos L. Alviar, MD, Bryan Doherty, MD, and Muthiah Vaduganathan, MD, MPH with invasive aspergillosis had evidence of pericardial infi ltration (6)(7)(8). Th is condition occurs primarily in severely immunocompromised patients and is generally a result of contiguous dissemination of Aspergillus from the lung or myocardium (9,10). Aspergillus inoculation into the pericardium after invasive cardiac surgery has been previously documented (11).…”

Recomendaciones para el tratamiento de la infección por Aspergillus spp.

“…La pericarditis aspergilosa aparece raramente en el contexto de una diseminación de la infección 27,55 . Acostumbra a ser secundaria a una diseminación hematógena, a la rotura de un absceso miocárdico o a diseminación directa desde el pulmón.…”