title: A case of invasive pulmonary aspergillosis with direct invasion of the mediastinum and the left atrium in an immunocompetent patient.
abstract: We report a case of invasive pulmonary aspergillosis invading the mediastinum and the left atrium. A 70-year-old woman was hospitalized for dyspnea. She had been well controlled for her diabetes mellitus and hypertension. The chest X-ray disclosed mediastinal widening, and the computed tomography scan of the chest showed that there was a large mediastinal mass and this lesion extended into the left atrium and right bronchus. The cardiac echocardiography showed that a huge mediastinal cystic mass compressed in the right atrium and a hyperechoic polypoid lesion in the left. The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which was stained with periodic acid-Schiff and Gomori's methenamine silver. Despite the treatment with antifungal agents, she died from cardiac tamponade after three months. Invasive pulmonary aspergillosis, which involves the mediastinum and the heart, is very rare in immunocompetent patients.
authors.affiliation: Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Kyu-Hyun
authors.initials: KH
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea. ; Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Shin
authors.affiliation: Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Hye Yun
authors.initials: HY
authors.lastname: Jeong
authors.affiliation: Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Ji Min
authors.initials: JM
authors.lastname: Chu
authors.affiliation: Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Hak Su
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Daejin
authors.initials: D
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Minjung
authors.initials: M
authors.lastname: Shim
authors.affiliation: Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea. ; Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Kim
keywords: Heart Neoplasms; Immunocompetence; Invasive Pulmonary Aspergillosis; Mediastinal Neoplasms
references.citation: Lancet Infect Dis. 2004 Jun;4(6):349-57
references.pmid: 15172343
references.citation: N Engl J Med. 2002 Aug 8;347(6):408-15
references.pmid: 12167683
references.citation: Scand J Infect Dis. 2002;34(11):819-22
references.pmid: 12578151
references.citation: Infect Immun. 2005 Jan;73(1):494-503
references.pmid: 15618189
references.citation: Rev Infect Dis. 1989 Mar-Apr;11(2):263-72
references.pmid: 2649962
references.citation: Clin Microbiol Infect. 2006 Nov;12(11):1060-76
references.pmid: 17002605
references.citation: J Med Case Rep. 2012 Sep 18;6:311
references.pmid: 22989346
references.citation: Mycopathologia. 2007 Apr;163(4):191-202
references.pmid: 17410480
references.citation: Medicine (Baltimore). 2000 Jul;79(4):250-60
references.pmid: 10941354
references.citation: Chest. 1986 Sep;90(3):451-2
references.pmid: 3743163
references.citation: J Hosp Infect. 2002 Mar;50(3):175-82
references.pmid: 11886192