Cardiac Aspergillosis in Patients With Acquired Immunodeficiency Syndrome: A Case Report and Review of the Literature

Abstract

Cardiac aspergillosis is uncommon in patients with acquired immunodeficiency syndrome (AIDS) in the absence of open heart surgery. We report a unique case of a 62-year-old man with AIDS who developed Aspergillus pancarditis with Aspergillus vegetations on mitral valve without evidence of pulmonary aspergillosis. There was extensive embolization to the brain and multiple foci of Aspergillus infection in kidneys and adrenal glands. There are only 10 documented cases of cardiac aspergillosis in the literature (1966–2003) in severely immunocompromised AIDS patients with CD4 T-lymphocyte counts ranging from 10 to 121 cells/μL. The cardiac aspergillosis could result from invasive pulmonary aspergillosis, either by hematogenous dissemination or by direct invasion, and skin Aspergillus infection can be carried through the bloodstream to the right heart in intravenous drug abusers. Most of the reported cases of cardiac aspergillosis were diagnosed at autopsy. Mortality among AIDS patients with cardiac aspergillosis is 100%, despite appropriate therapy.

Cardiovascular Dynamics in HIV: The Influence of Adrenal Function and Nutritional Status

“…More recent research papers in the era of ART focus exclusively on the clinical phenotype. Pathological findings in the adrenal glands of patients with AIDS include cytomegalovirus, 48–56 mycobacterium avium complex, 49,57 cryptococcus, 58 tuberculosis, 59 toxoplasmosis, 58,60,61 cryptosporidiosis, 60 Kaposi sarcoma, 49,58,59,62,63 lymphoma, 59,64,65 aspergillus, 66 leishmania, 60 pneumocystis carinii, 67 herpes simplex, 61 histoplasmosis, 61 trypanosomiasis, 61 and adrenal hemorrhage. 61 In one autopsy series, the adrenal gland was the most common extrapulmonary site of cytomegalovirus inclusions in AIDs, with 40% of the patients having this finding.…”