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2. Vol. 32 No. 3 Sep.-Dec. 2015

Taweegrit Siripongboonsitti M.D., M.Sc., Onwalee Dhissayakamol M.D., Opass Putcharoen M.D., M.Sc., Gompol Suwanpimolkul M.D.

Aspergillus native valve endocarditis is a very rare condition but results in high mortality rate. The author reports a case of a 62-year-old Thai male, with past history of intravenous drug use.  The patient presented with sudden onset of right leg pain for 3 hours.  Physical examination revealed afebrile, pan-systolic murmur at the apex, diastolic blowing murmur at the left upper parasternal border and peripheral signs of aortic regurgitation.  The right leg was cold, pale, paretic and pulseless below popliteal area.  Computed tomographic angiography of the lower extremities demonstrated segmental occlusion from the distal right common femoral artery to the proximal superficial femoral artery.  Emergency embolectomy was performed.  The pathology reported septic fungal emboli and compatible with Aspergillus spp.  Transthoracic echocardiography showed a peri-valvular abscess, 3´5 mm in size at the aorto-mitral continuity, and a vegetation 25´15 mm in size, located at the anterior mitral leaflet.  Aspergillus endocarditis was diagnosed.  The patient was initially treated with intravenous deoxycholate amphotericin B, which was later switched to intravenous voriconazole, when Aspergillus spp. had been identified from clot culture.  The patient underwent mitral and aortic valve replacement.  The pathology of the vegetations and valve tissue of aortic valve showed fungal hyphae at both the mitral and aortic valve. Finally, Aspergillus flavus was identified from the tissue culture of valves and vegetations, and the patient was successfully treated with aortic and mitral valve replacement, along with antifungal therapy.  (J Infect Dis Antimicrob Agents 2015;32:151-61.)

Keyword : Aspergillus endocarditis, Fungal endocarditis, Aspergillus flavus, Aspergillus, culture negative endocarditis, endocarditis, native valve endocarditis, fungal IE, Aspergillus IE