Aspergillus fumigatus, a rare cause of fatal coronary artery occlusion

Abstract

Endocarditis by Aspergillus species in patients without prior cardiovascular surgery is extremely rare and difficult to diagnose. We report and discuss a 69-year-old patient with hairy cell leukemia who developed severe bilateral pneumonia and metastatic subcutaneous nodules from which A. fumigatus was cultured. He died after 18 days of treatment with an adequate dose (0.7 mg/kg/day) of amphotericin B intravenously. Fungal endocarditis and a myocardial infarction due to a septic thrombotic occlusion of the left coronary artery by A. fumigatus appeared to be the cause of death. A. fumigatus could still be cultured from the aortic valve postmortem despite a total dose of 756 mg amphotericin B. In case of metastatic spread of Aspergillus spp., endocarditis should be suspected.