AspergillusPericarditis with Tamponade in a Renal Transplant Patient

Abstract

Aspergillus pericarditis is a rare and life-threatening infection in immunosuppressed patients. It has nonspecific clinical manifestations that often mimic other disease entities especially in patients who have extensive comorbidities. Diagnosis is oftentimes delayed and rarely done antemortem. A high degree of suspicion in immunocompromised patients is necessary for evaluation and timely diagnosis. This is a case of Aspergillus pericarditis with cardiac tamponade in a renal transplant patient with liver cirrhosis. Two months after transplant, he developed decompensation of his cirrhosis from hepatitis C, acute cellular rejection, and Kluyvera bacteremia, followed by vancomycin-resistant Enterococcus faecium (VRE) bacteremia. Four months after transplant, the patient presented with lethargy and fluid overload. He subsequently developed shock and ventilator-dependent respiratory failure. An echocardiogram showed pericardial effusion with cardiac tamponade. He had emergent pericardiocentesis that showed purulent drainage. He was started on broad-spectrum antibiotics. Amphotericin B was initiated when the pericardial fluid grew mold that was later identified as Aspergillus fumigatus. The patient quickly decompensated and expired.

Unusual presentation of aspergillus pericarditis: A case report

“…[5] Similarly, Aspergillus are known to infect the heart but not the pericardium and are rarely isolated premortem. [45] In the case described here, an occurrence of aspergillus pericarditis was accidentally detected during the double-valve surgery to treat the initial diagnosis. Subsequently, the patient was successfully managed with voriconazole.…”

“…Fungal infection of the pericardium is rare. [4] In an autopsy study that analyzed 60 patients with fungal infections of the heart, only 2 cases (3.5%) were found to have had pericardial infection. [5] Similarly, Aspergillus are known to infect the heart but not the pericardium and are rarely isolated premortem.…”

“…The diagnosis of aspergillus pericarditis is very challenging owing to its lack of characteristic signs and symptoms. According to Biso et al ,[4] aspergillus pericarditis most commonly presents as chest pain, hypotension, cardiac tamponade and pericardial friction rub. [4] However, Le Moing et al [3] found that of the 30 cases with aspergillus pericarditis, only 8 presented with cardiac tamponade.…”

“…According to Biso et al ,[4] aspergillus pericarditis most commonly presents as chest pain, hypotension, cardiac tamponade and pericardial friction rub. [4] However, Le Moing et al [3] found that of the 30 cases with aspergillus pericarditis, only 8 presented with cardiac tamponade. Our patient presented with abdominal pain, tachypnea, tachycardia, pansystolic murmurs, bilateral course crepitation and decreased oxygen saturation, which were unusual presentations.…”

Pericarditis due to Campylobacter coli infection: a case report

“…When β-D-glucan is high, it generally suggests the presence of fungal infection [ 14 ]. When Candida or Aspergillus fungi were cultured from pericardial fluid, some cases of Candida pericarditis or aspergillus pericarditis were diagnosed [ 15 – 20 ]. Physical examination, chest CT, and blood and pericardial effusion cultures ruled out fungal pericarditis, fungal pneumonia, and fungal bacteremia.…”