Aspergillus infectious
endocarditis (IE) is a rare cause of culture-negative
endocarditis. The main risk factors are severe immunosuppression and prosthetic heart valve. We describe a case of Aspergillus fumigatus IE on a native mitral valve in a patient with
autoimmune hepatitis in remission while on low dose
corticosteroids. The case is unique due to the patients' low initial risk for invasive
fungal disease, its clinical presentation and successful management with emergency surgery and antifungal
therapy. After literature review we have not found a similar case report. The patient presented with right-sided eyesight deterioration due to
endophthalmitis.
Vitrectomy was performed and Aspergillus fumigatus grew on culture. IE on a native mitral valve was confirmed with echocardiography. The patient developed signs of acute
heart failure soon after hospital admission and was diagnosed with several septic emboli (kidney, spleen, thumb, right common femoral artery). He was initially treated with
surgical valve replacement, dual antifungal
therapy with
liposomal amphotericin B (LAmB) and
voriconazole and
vitrectomy, including intravitreal
amphotericin B application. Long-term
triazole therapy was not possible due to hepatotoxicity. The patient was maintained on intermittent LAmB for 12 months and is without signs of recurrence ten months after
therapy was discontinued. Aspergillus can cause invasive
infection in patients with
autoimmune hepatitis on low dose
corticosteroids. Early diagnosis followed by emergency
surgical valve replacement and systemic antifungal
therapy can improve prognosis. Additional studies are needed to evaluate alternative methods and duration of antimicrobial
therapy following Aspergillus IE.