galactomannan and Amaurosis-Fugax

Native valve endocarditis caused by Aspergillus spp. is an uncommon disease with a high mortality rate. Generally, Aspergillus is isolated from affected valve in post-mortem or biopsy specimens. However, its isolation from blood cultures is exceedingly rare. We report a case of fungal endocarditis in a native mitral valve with the isolation of Aspergillus fumigatus both in valve vegetation and in blood culture bottles. The patient underwent valve replacement and antifungal treatment with voriconazole and caspofungin, but he died on post-operative day 45 with disseminated aspergillosis confirmed by necropsy. Paradoxically, galactomannan antigen detection in serum was negative. This is the third case of Aspergillus endocarditis with positive blood culture reported in the literature.

Topics: Amaurosis Fugax; Aneurysm, Infected; Antifungal Agents; Antigens, Fungal; Aspergillosis; Aspergillus fumigatus; Biomarkers; Caspofungin; Combined Modality Therapy; Echinocandins; Endocarditis; False Negative Reactions; Fatal Outcome; Fungemia; Galactose; Heart Valve Prosthesis Implantation; Humans; Infarction; Kidney; Lipopeptides; Male; Mannans; Mesenteric Arteries; Mesenteric Vascular Occlusion; Middle Aged; Mitral Valve; Peptides, Cyclic; Pulmonary Disease, Chronic Obstructive; Pyrimidines; Renal Artery; Triazoles; Voriconazole