Stroke due to septic embolism resulting from Aspergillus aortitis in an immunocompetent patient

Abenza-Abildúa, M J; Gimeno, Blanca Fuentes; Morales-Bastos, Carmen; Aguilar-Amat, María José; Martínez‐Sánchez, P.; Díez‐Tejedor, Exuperio

doi:10.1016/j.jns.2009.04.037

Cited by 12 publications

(6 citation statements)

References 5 publications

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“…Upon reflection, the patient recalled an event ∼3 years prior when he was placing mulch in his yard, which had caused mild respiratory symptoms. In the outside environment Aspergillus is known to be ubiquitous and can be internalized by inhalation 1, 2, 3, 4. The most common source for Aspergillus endoaortitis is pulmonary,5, 6 which represents a possible source of infection in this patient.…”

Section: Discussionmentioning

confidence: 99%

Aspergillus thromboembolism from a mycotic ascending aortic pseudoaneurysm

Skibba

West

Evans

et al. 2015

Journal of Vascular Surgery Cases

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This case report describes an immune-competent patient with acute upper extremity ischemia caused by thromboembolism from an Aspergillus-infected ascending aortic pseudoaneurysm. Efforts to identify the source of an acute arterial thromboembolic occlusion should be made, and a high index of suspicion for mycotic infection should be maintained in patients with an atypical presentation, such as fevers of unknown origin. Additional measures, such as pathologic examination of thromboembolic debris, blood cultures, and positron emission tomography, should be performed to identify the etiology in these unexplained situations. (J Vasc Surg Cases 2015;1:94-6.) Mycotic thromboembolization is a rare cause of acute large-vessel arterial occlusion. This case report describes an immune-competent patient with acute upper extremity ischemia caused by embolization from an Aspergillusinfected ascending aortic pseudoaneurysm. Signed consent was obtained from the patient for publication. CASE REPORTA 57-year-old man, who had undergone coronary artery bypass grafting (CABG) 5 years prior to presentation, was admitted to an outside facility with a 4-day history of fevers and a 24-hour history of numbness and tingling in his right upper extremity. The patient was noted to have an absent radial pulse. Duplex ultrasound imaging demonstrated a brachial artery occlusion. The patient was transferred to our institution for further evaluation and treatment.Upon arrival, the patient was taken emergently to the operating room for thromboembolectomy. A Fogarty catheter was used to remove w5 cm of normal-appearing clot after multiple passes, with subsequent return of a strong radial pulse, a weak ulnar pulse, and brisk capillary refill in all fingers. The patient was maintained on intravenous systemic anticoagulation.A postoperative electrocardiogram demonstrated sinus rhythm. A transthoracic echocardiogram was negative for an embolic source. A transesophageal echocardiogram with bubble study likewise confirmed the absence of vegetation or clot within the heart. A computed tomography (CT) angiogram of the chest demonstrated a 7.2-cm saccular pseudoaneurysm of the ascending aorta, which had not been seen on either echocardiogram (Figs 1 and 2).Pathologic examination of the clot using hematoxylin and eosin and Grocott methenamine silver stains unexpectedly found hyphae with parallel and acute angle branching, morphologically consistent with Aspergillus (Fig 3). Voriconazole systemic antifungal therapy was initiated.Human immunodeficiency virus serologic testing was negative. The results of a complete blood count with differential were within expected limits, and blood cultures were negative for growth. A head CT was negative for disseminated infection, and the chest CT likewise had not shown pulmonary disease. An ophthalmologic examination was negative for fungal endophthalmitis.The patient was transferred to a cardiac surgery unit with additional capabilities. A positron emission tomography (PET) scan confirmed localized infection to the asce...

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Section: Discussionmentioning

confidence: 99%

Aspergillus thromboembolism from a mycotic ascending aortic pseudoaneurysm

Skibba

West

Evans

et al. 2015

Journal of Vascular Surgery Cases

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“…Multiple embolic events are known to occur in patients with Aspergillus endocarditis [ 1 ] and aortitis [ 2 , 5 , 6 ]. However, repeated trans-esophageal echocardiograms and magnetic resonance aortogram did not show valve defects, vegetations, aortitis or aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…Embolizations to cerebral, lower limb, mesenteric and renal vasculature have been reported. Aspergillus aortitis is also known to cause distant embolic phenomena [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Embolizing pulmonary aspergillosis, mycobacterial & aspergillous splenic abscess and cytomegalovirus co-infection following steroid induced immunosuppression: a case report

et al. 2018

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BackgroundAspergillosis is a serious infection particularly affecting the immunodeficient host. Its co-infection with tuberculosis and cytomegalovirus has not been reported before. Embolic events are well recognized with aspergillous endocarditis and aortitis. Splenic abscess is a rare serious complication of disseminated aspergillosis and is difficult to treat. We report the first case of multiple embolic events and splenic abscess in a patient with pulmonary aspergillosis and cytomegaloviral and tuberculous co-infection, without endocarditis or aortitis.Case presentationThirty-year-old male presented with fever and non-productive cough while on glucocorticoids for glomerulonephritis. He was found to have pulmonary aspergillosis and subsequently developed bilateral lower limb and cerebral fungal emboli and fungal abscess in the spleen. He had IgM and B cell deficiency and cytomegalovirus (CMV) and tuberculous co-infections. He recovered after prolonged course of antimicrobials, splenectomy and cessation of glucocorticoid therapy which also lead to the resolution of immune deficiencies.ConclusionThis report illustrates rare combination of B and T cell suppressive effects of glucocorticoids leading to co-infections with CMV, Mycobacterium tuberculosis and Aspergillus and systemic fungal embolization from pulmonary aspergillosis.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3293-4) contains supplementary material, which is available to authorized users.

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“…The etiologies of postoperative fever in children after TFB with BAL are still unclear. With the exception of rare cases of sepsis after TFB with BAL among immunodeficient patients, infections do not seem to play significant roles, and postoperative hemograms are different in infections and postoperative fever . Cytokines, mainly IL‐1β, IL‐6, and TNF‐α, are known to cause fever by raising the thermoregulatory center in the hypothalamus, and glucocorticosteroids could suppress fever and IL‐6 response due to an inflammatory state .…”

Section: Discussionmentioning

confidence: 99%