Pacemaker Associated Aspergillus fumigatus Endocarditis: A Case Report

Abstract

Aspergillus endocarditis (AE) is a highly fatal infection that can occur in heart valve replacement, pacemaker implantation and other heart surgeries, and early recognition and sufficient diagnosis are challenging. Here, we report the case of a 68-year-old male with a history of dilated cardiomyopathy and pacemaker implantation who had a repeated fever with failed antibacterial treatment and sterile blood culture. He developed endocarditis, and the culture and biopsy of vegetation tissue showed the abundant presence of septate hyphae, which was subsequently identified as Aspergillus fumigatus by internal transcribed spacer (ITS) sequencing. Although the patient had serious side effects from voriconazole, he had a good prognosis following surgery and prolonged caspofungin antifungal therapy of 42 consecutive days. We discuss the diagnosis and treatment strategy of AE, and recommend galactomannan assays and next-generation sequencing for a timely diagnosis. Early surgical intervention combined with prompt antifungal therapy appears significant for survival.

Keywords:

• Aspergillus endocarditis
• AE
• Aspergillus fumigatus
• vegetation
• culture
• fever

Data Sharing Statement

The datasets used and/or analysed during the current study are available from the corresponding author Yumei Ge on reasonable request.

Ethics Approval and Consent to Participate

This study was supported by the Ethics Committee of Zhejiang People’s Hospital (Ethics Committee Approval of Biomedical Research Involving Humans, Approval No.:2022JS008) and was carried out in accordance with the ethical standards of the Declaration of Helsinki.

Consent for Publication

Written and informed consent was obtained from the patient for publication of this Case Report and any accompanying images.

Acknowledgments

We thank all members of the microbiology laboratory of Zhejiang Provincial People’s Hospital for their help in the collection of clinical data.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

This study was supported by the New Project of Zhejiang Provincial People’s Hospital entitled “Construction of Rapid Nucleic Acid Detection Platform for Invasive Fungi” (20211214).