Aspergillus fumigatusEndocarditis

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Abstract
A 39 year old chronic alcoholic, with advanced cirrhosis of the liver died from the complications of A. fumigatus endocarditis of the aortic valve. An antemortem diagnosis was made by histological examination and culture of embolic material removed from the lower abdominal aorta 10 days before death. Autopsy revealed large pale brown anterior aortic vegetation composed of Aspergillus hyphae similar to those of the embolus, perforation of the cusp through the vegetation, and a mycotic aneurysm extending directly into the interventricular septum and rupturing into the right atrium at 2 points. Embolization had occurred to the myocardium, aortic bifurcation (recurrent), spleen, liver, kidneys, and brain, with colonies of hyphae in both kidney and liver. A. fumigatus was cultured from both aortic and mitral vegetations. A purulent Staphylococcal bronchitis with early bronchopneumonia was present, and a hard nodular liver. Fusion of the cusps at the left anterior aortic commissure with slight local calcification may have favored valvular implantation of the fungus. No portal of entry was discovered. Debilitating or predisposing factors are liver cirrhosis, treatment with penicillin and chloramphenicol for pneumonia 3 months earlier, and with methicillin, penicillin, and streptomycin during last admission. Amphotericin B was administered 5 days before death but had no demonstrable effect.