Aspergillus endocarditis in patients without prior cardiovascular surgery: Report of a case in a liver transplant recipient and review

Aspergillus flavus mural endocarditis was diagnosed after death in a 19-year-old man who had undergone orthotopic liver transplantation 4 months before death. His course was complicated by severe acute graft rejection, which required additional transplants 2 and 4 months, respectively, after the first. Review of the medical literature documented an additional 28 cases of aspergillus endocarditis in patients without prior cardiac surgery. The majority of the patients were immunosuppressed. The most common presenting feature was fever, and embolic phenomena occurred in half of the patients during illness. No blood cultures yielded Aspergillus species. Laboratory findings werenonspecific. The diagnosis was made before death in only seven cases. It was based on histologic examination of either embolectomy tissue (four patients) or skin biopsy tissue (one patient) and on echocardiographic demonstration of vegetations (two patients). Echocardiography failed to show vegetations in five of nine cases tested. Two patients survived. Aspergillus endocarditis should be considered in an immunocompromised host who presents with fever and embolic phenomena, with or without a cardiac murmur, and whose blood cultures are sterile.