title: Rapidly advancing invasive endomyocardial aspergillosis.
abstract: The exposure to Aspergillus organisms/spores is likely common, but disease caused by tissue invasion with these fungi is uncommon and occurs primarily in the setting of immunosuppression. We report a case of rapidly advancing invasive endomyocardial aspergillosis secondary to prolonged usage of multiple broad-spectrum antibiotics in a nonimmunocompromised host. A 36-year-old cotton textile worker presented to our institution with a 3-month history of weight loss and fatigue. He reported receiving prolonged use of multiple broad-spectrum antibiotic treatment. The echocardiogram demonstrated multiple endomyocardial vegetations and a mass in the left atrium. Myocardial biopsy specimen revealed an invasive endomyocardial aspergillosis. The patient was investigated for immune deficiency including HIV, and this workup was negative. Treatment was started with amphotericin B and heparin for presumed left atrial thrombus. The patient died because of a rupture of mycotic aneurysm that resulted in cerebral hemorrhage. This case illustrates the risk of an invasive fungal infection in a nonimmunocompromised host who is a prolonged user of antibiotics in the setting of environmental exposure of opportunistic invasive fungal infections.
authors.affiliation: Departments of Cardiology and Pathology, Gaziantep University School of Medicine, Sahinbey Medical Center, TR-27310 Sahinbey/Gaziantep, Turkey. davutoglu@gantep.edu.tr
authors.forename: Vedat
authors.initials: V
authors.lastname: Davutoglu
authors.forename: Serdar
authors.initials: S
authors.lastname: Soydinc
authors.forename: Abdullah
authors.initials: A
authors.lastname: Aydin
authors.forename: Metin
authors.initials: M
authors.lastname: Karakok
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology; D001232:Aspergillus fumigatus; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000382:microbiology; D017809:Fatal Outcome; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000382:microbiology; D008297:Male; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012421:Rupture; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000666:Amphotericin B