Non-valvular Infective Endocarditis Caused by Sarocladium kiliense in an Immunocompromised Patient with Aplastic Anemia

Abstract

Sarocladium kiliense is ubiquitous in the human environment and is an emerging opportunistic pathogen, especially among immunocompromised hosts. A 77-year-old man diagnosed with aplastic anemia suffered from non-valvular endocarditis. After he passed away, fungal hyphae were observed in several lesions on a postmortem examination. Polymerase chain reaction (PCR) and a DNA sequence analysis revealed S. kiliense as the causative organism. This is the first case report of non-valvular fungal endocarditis caused by S. kiliense identified by PCR and a DNA sequence analysis in an immunocompromised patient. Although rare, invasive fungal infection caused by S. kiliense should be considered in immunocompromised hosts.

Keywords: Sarocladium kiliense; aplastic anemia; immunocompromised host; infective endocarditis; non-valvular vegetation.

Figure 1.

Contrast computed tomography findings. A, B: Chest computed tomography shows consolidations in the apex of the left lung and the right middle lung (arrows). C, D: Abdominal computed tomography shows low-density lesions in the spleen and non-enhancing lesions in the right kidney (arrows).

Figure 2.

A transthoracic echocardiogram taken using a four-chamber view shows a vegetation (arrow) attached to the basal interventricular septum. LA: left atrium, LV: left ventricle, MV: mitral valve, RA: right atrium, RV: right ventricle

Figure 3.

Clinical course after the first visit to our hospital. ABPC/SBT: ampicillin/sulbactam, AMPC/CVA: amoxicillin/clavulanic acid, ATG: anti-thymocyte globulin, CRP: C-reactive protein, CsA: cyclosporine, EPAG: eltrombopag, ITCZ: itraconazole, LVFX: levofloxacin, VCM: vancomycin, VRCZ: voriconazole, WBC: white blood cell

Figure 4.

Findings of a Sarocladium kiliense vegetation at autopsy. A: A vegetation attached to the left ventricular wall (arrow). B, C: Grocott’s methenamine silver stain of the vegetation. D-F: Scanning electron microscopy photographs of the vegetation.