Giant Candida Mycetoma in an Ascending Aorta Tubular Graft

Abstract

We report the case of a 46-year-old male hospitalized for abdominal pain and fever with history of a David procedure followed by an aortic valve replacement due to severe aortic regurgitation. Transesophageal echocardiography (TEE) and computed tomography showed a large mass floating in the aorta. After surgical excision of the vegetation, attached to the Dacron prosthesis, histological examination revealed Candida hyphae and spores confirming the diagnosis of a mycetoma in an ascending aorta tubular graft. At six-month follow-up, the patient was in good clinical condition without recurrence of the fungal mass on TEE.

Management of thoracic aortic graft infections

“…Immunosuppressed patients are also predisposed to the development of fungemia and can seed aortic grafts without overt clinical signs of sepsis. Infection of thoracic aortic grafts with candida is rare with a total of only six case reports in the literature . Of the six patients, five required surgical aortic graft replacement and one patient was treated only with antifungals and close follow‐up.…”

Ascending Aortic Graft Pseudoaneurysm With Sternal Erosion: A Presentation of Candidal Infection

“…A thorough literature review retrieved only five cases of aortic graft infections secondary to Candida species involving the thoracic aorta, with the infectious process invariably localized to the confines of the aortic graft [1][2][3][4][5]. Nicolini and colleagues [1] reported a 71-year-old man with thrombosis of an ascending aortic graft, which was replaced with a Dacron vascular prosthesis.…”

“…The patient eventually succumbed to systemic candidiasis 3 months after the operation. Di Benedetto and colleagues [2] described a 46-year-old man presenting with a 14-cm floating mycetoma arising from an ascending aortic graft after an aortic valve conduit replacement. Treatment involved supracoronary excision and ascending aortic replacement with a Dacron graft.…”

Robotic-assisted closed-chest management of a fungal-infected prosthetic aortic graft: a case report

“…The majority of prosthetic aortic graft infections tend to be bacterial, with Gram-positive organisms constituting at least half of all positive tissue cultures [ 5 ]. Fungal infections, although less common, have been reported, although typically in either single case reports or small case series, and have usually been described in immunocompromised patients or in those with other predisposing risk factors for fungemia, with Candida species being the most frequently identified pathogen [ 3 , 6 , 7 ]. Most patients with thoracic aortic graft infections tend to present with classic symptoms and signs indicative of sepsis, although these may be more subtle in the setting of less virulent organisms and include more nonspecific complaints, such as fatigue, malaise, and/or weight loss [ 8 ].…”