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

Itoh, Mitsuru; Takahashi, Masahiko; Mori, Miyuki; Tamekiyo, Hiromichi; Yoshida, Hiroshi; Yago, Kazuo; Shimada, Hideto; Arai, Kazumori

doi:10.2169/internalmedicine.45.1607

Cited by 7 publications

(6 citation statements)

References 32 publications

(36 reference statements)

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“…Pericardial involvement results either from mycotic emboli deriving from pulmonary circulation in the context of haematogenous dissemination or directly from endocardium. 10,[26][27][28] Pericardial fluid might be detected and is usually purulent. In fact, two of our patients showed pericardial involvement, thrombi or fungal masses.…”

Section: Discussionmentioning

confidence: 99%

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Endomyocardial and pericardial aspergillosis in critically ill patients

Dimοpoulos

Frantzeskaki

Kosmopoulos

et al. 2017

Mycoses

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Invasive aspergillosis(IA) is a potentially lethal complication of Aspergillus infection affecting mainly immunocompromised hosts; however, during the last two decades its incidence was increasingly observed in critically ill immunocompetent patients. The objective of this study is to describe the clinical characteristics of histologically proven endomyocardial and pericardial invasion, in the context of IA, in critically ill patients. Eight critically ill patients with histopathological confirmation of endomyocardial/pericardial aspergillosis were evaluated. Risk factors, clinical and laboratory characteristics, treatment, histopathological characteristics and mortality were recorded. Signs and symptoms of cardiac dysfunction were not observed in any of the patients. Therapy was administered to six of them shortly after the first positive culture. The observed histopathological lesions included haemorrhagic lesions, small vessels with central thrombosis and surrounding consolidated tissue with necrosis. Voriconazole, caspofungin, lipid amphotericin B and itraconazole were the used antifungals. The mortality rate was high (87.5%). Endomyocardial and pericardial aspergillosis are devastating complications of invasive aspergillosis. Clinical suspicion is low making the diagnosis difficult, therefore histopathological examination of tissues are required. The mortality is high.

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Section: Discussionmentioning

confidence: 99%

“…Patients may suffer from cardiac tamponade, arrhythmias or infarction. Pericardial involvement results either from mycotic emboli deriving from pulmonary circulation in the context of haematogenous dissemination or directly from endocardium . Pericardial fluid might be detected and is usually purulent.…”

Section: Discussionmentioning

confidence: 99%

Endomyocardial and pericardial aspergillosis in critically ill patients

Dimοpoulos

Frantzeskaki

Kosmopoulos

et al. 2017

Mycoses

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“…Cardiac aspergillosis, in particular, is one of the most serious complications of systemic aspergillosis. Various clinical symptoms have been reported, including myocardial infarction, myocarditis, endocarditis, pericarditis, pericardial tamponade, superior vena cava syndrome, aortitis, intracardiac mass formation and atrioventricular block (5).…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac involvement of aspergillosis, including myocardial infarction, myocarditis, and pericarditis, is considerably rare, and treating cardiac aspergillosis is very difficult, even when accurately diagnosed. Cardiac aspergillosis is rarely diagnosed before death, and is usually fatal (5). We herein report a case of acute STelevation myocardial infarction (STEMI) caused by Aspergillus embolism in the coronary artery.…”

Section: Introductionmentioning

confidence: 98%

Acute Myocardial Infarction Caused by Coronary Embolism from <i>Aspergillus</i> Endocarditis

Seo

Seol

et al. 2014

Intern. Med.

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Although the primary cause of acute coronary syndrome is atherosclerotic disease, it is important to include other causes of acute myocardial infarction. This report describes the case of a 53-year-old man with acute myeloid leukemia, who was referred to our cardiology department for treatment of acute myocardial infarction with ST segment elevation on an electrocardiogram. Portable echocardiography showed large areas of vegetation on the anterior mitral leaflet, while coronary angiography demonstrated the total occlusion of the left anterior descending artery. A histologic examination of the embolectomy specimen confirmed the presence of Aspergillus fungal thrombi. This report highlights a rare case of fatal Aspergillus endocarditis with myocardial infarction due to embolism in an immunosuppressed patient.

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“…Changes in the myocardium may not be visible on echocardiography or CT [23]. Nuclear scans and electrocardiograms may show dysfunction of the myocardium, but these are not specific [24,25]. Mural endocarditis, is characterized by multiple small vegetations and observation of these in the appropriate setting with appropriate imaging is highly suggestive of Aspergillus myoendocarditis [26].…”

Section: Imagingmentioning

confidence: 99%

Cardiac Aspergillosis

Lagacé-Wiens¹,

Rubinstein²

2009

Aspergillosis: From Diagnosis to Prevention

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Cardiac aspergillosis has been increasingly recognized as a complication of immunocompromise in recent times. The use of progressively more potent immunosuppressive agents and the longer survival times of transplant recipients is likely contributing to an increasing prevalence of the disease. Although still uncommon, the disease has an extremely high mortality rate and management remains difficult. Cardiac aspergillosis can present as combinations of endocarditis, myocardial invasion or pericarditis and commonly occurs in the context of disseminated aspergillosis. Myocardial involvement is most common, followed by endocarditis although the various forms frequently co-exist. Diagnosis is challenging and is frequently only done post-mortem. Culture diagnosis is best achieved with tissue (valve or biopsy), since blood culture is frequently negative. Any cardiac findings on imaging or physical examination in the context of disseminated aspergillosis suspected by culture, histology or antigen assay should be assumed to be cardiac aspergillosis and investigations for endocarditis should be undertaken. Treatment of cardiac aspergillosis is usually not successful and has not been systematically studied. For endocarditis, surgical and medical therapy are indicated, and medical therapy with either combination amphotericin B and flucytocine or the newer triazoles is suggested. Other forms of cardiac involvement are best managed as disseminated aspergillosis, with a low threshold for diagnosis of endocarditis.

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

Abstract: Abstract

Cited by 7 publications

References 32 publications

Endomyocardial and pericardial aspergillosis in critically ill patients

Endomyocardial and pericardial aspergillosis in critically ill patients

Acute Myocardial Infarction Caused by Coronary Embolism from <i>Aspergillus</i> Endocarditis

Cardiac Aspergillosis

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