Aspergillus flavus endaortitis following aortic valvotomy

Abstract

Aspergillar endaortitis does not seem to have been described before in the English literature. Our patient had undergone aortic valvotomy and subsequently developed leg pains, migratory arthralgias, periarticular swelling, and general malaise. Mild intermittent pyrexia, evanescent petechiae, splinter haemorrhages, and peripheral small artery occlusion characterized the early course in hospital. Dramatic popliteal artery occlusion led to surgical recovery of embolic material packed with mycelia of Aspergillus flavus, but the patient died despite intravenous amphotericin B therapy. Necropsy revealed endaortitis and aspergilli were demonstrated in the wall of a saccular dilatation of the ascending aorta close to non-absorbable sutures. The relevant literature is reviewed and attention is drawn to the current implications of knowledge relating to risk factors, diagnosis, and treatment. We suggest that cardiovascular aspergillosis will now be encountered more frequently and that a different therapeutic approach is justified.