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Case Reports
. 2022 Oct 31:9:1045353.
doi: 10.3389/fcvm.2022.1045353. eCollection 2022.

Case report: Disseminated Scedosporium apiospermum infection with invasive right atrial mass in a heart transplant patient

Baudouin Bourlond  1 , Ana Cipriano  2 , Julien Regamey  1 , Matthaios Papadimitriou-Olivgeris  2 , Christel Kamani  1   3 , Danila Seidel  4   5   6   7 , Frederic Lamoth  2   8 , Olivier Muller  1 , Patrick Yerly  1
Affiliations
Case Reports

Case report: Disseminated Scedosporium apiospermum infection with invasive right atrial mass in a heart transplant patient

Baudouin Bourlond et al. Front Cardiovasc Med. .

Erratum in

Abstract

Scedosporium apiospermum associated endocarditis is extremely rare. We report a case of a disseminated S. apiospermum infection with an invasive right atrial mass in a 52-year-old male, 11 months after heart transplantation, referred to our institution for an endogenous endophthalmitis with a one-month history of diffuse myalgias and fatigue. The patient had been supported two times with extracorporeal membrane oxygenation (ECMO) during the first three postoperative months. The echocardiography on admission revealed a mass in the right atrium attached to a thickened lateral wall. The whole-body [18F]FDG PET/CT revealed systemic dissemination in the lungs, muscles, and subcutaneous tissue. Blood cultures were positive on day three for filamentous fungi later identified as S. apiospermum. The disease was refractory to a 3-week dual antifungal therapy with voriconazole and anidulafungin in addition to reduced immunosuppression, and palliative care was implemented.

Keywords: Lomentospora prolificans; PET/CT; Scedosporium apiospermum; heart failure; heart tranplantation; infective endocarditis; mycoses.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Painful purplish cutaneous nodules (A), pathology examination with Periodic Acid Schiff coloration 10x (B), and colorations with GROCOTT stain of cutaneous nodules showing regular septate filaments connected with 45-degree divisions 10x (C) and 40x (D).
FIGURE 2
FIGURE 2
Right atrium mass (15 × 18 mm) with thickened lateral wall without associated tricuspid valve anomalies as shown in transthoracic echocardiography [green arrow, Panel (A)] and transesophageal echocardiography [green arrow, Panel (B)].
FIGURE 3
FIGURE 3
18F-fluodeoxyglucose ([18F]FDG) Positron emission tomography (PET)/computed tomography angiography (CTA) findings. Left: Maximum intensity projection image of the whole body showing pathological focal diffuse [18F]FDG uptake of the trunk as well as the upper and lower extremities. Right: (A) Cardiac CTA showing an heterogeneous mass with irregular margins, in contact with the lateral wall of the right atrium with extension in the pericardial space. (B) Transaxial view of [18F]FDG PET/CTA showing pathological [18F]FDG accumulation of the right atrial mass, suggestive of an active infectious process. (C) Transaxial view of [18F]FDG PET/CTA showing focal subpleural nodules with increase [18F]FDG accumulation in the left lung, suggestive of septic emboli. (D) Coronal view of [18F]FDG PET/CT showing focal increased cutaneous and subcutaneous [18F]FDG accumulation in the proximal part of the lower limbs, suggestive of septic emboli.
See this image and copyright information in PMC

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