title: Post-operative Aspergillus mediastinitis in a man who was immunocompetent: a case report.
abstract: BACKGROUND
  Aspergillus spp. infections mainly affect patients who are immunocompromised, and are extremely rare in immunocompetent individuals.
  
  
  METHODS
  Aspergillus post-operative mediastinitis is considered to be a devastating infection, usually affecting patients undergoing cardiothoracic surgery with specific predisposing factors. We describe the case of an immunocompetent 68-year-old Caucasian man with severe chronic thromboembolic pulmonary hypertension, who underwent pulmonary thromboendarterectomy and developed post-operative mediastinitis due to Aspergillus flavus. The environmental control did not reveal the source of A. flavus infection and, despite combined antifungal therapy, our patient died as a result of septic shock and multiple organ failure.
  
  
  CONCLUSIONS
  Aspergillus mediastinitis mainly affects patients after cardiosurgery operations with predisposing factors, and it is unusual in patients who are immunocompetent. The identification of the Aspergillus spp. source is often difficult, and there are no guidelines for the administration of pre-emptive therapy in this population of at-risk patients.
authors.affiliation: Second Department of Critical Care Medicine, 'ATTIKON' University Hospital, University of Athens Medical School, Athens Greece. dimop@vodafone.net.gr.
authors.forename: George
authors.initials: G
authors.lastname: Dimopoulos
authors.forename: Iraklis
authors.initials: I
authors.lastname: Tsangaris
authors.forename: Garyphalia
authors.initials: G
authors.lastname: Poulakou
authors.forename: John
authors.initials: J
authors.lastname: Panayiotides
authors.forename: George
authors.initials: G
authors.lastname: Tsaknis
authors.forename: Stylianos
authors.initials: S
authors.lastname: Orfanos
authors.forename: Apostolos
authors.initials: A
authors.lastname: Armaganides