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Aspergillus aortitis: a cause for aortic perforation in a patient following combined aortic valve surgery and liver transplantation

^a Department of Cardiothoracic Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK
^b Department of Histopathology, King's College Hospital, Denmark Hill, London SE5 9RS, UK

^* Corresponding author. Tel.: +44-20-7346-3191; fax: +44-20-7346-3433
rhanvesakul{at}doctors.org.uk

We report a case of aspergillus fumigatus aortitis in a patient following combined aortic valve replacement and orthotopic liver transplantation for significant aortic stenosis and alcoholic liver cirrhosis. At operation, a suspicious excavating lesion was found on the native aortic valve and specimen sent for culture. The ascending aorta and aortic sinuses were found to be normal. Routine immunosuppression was commenced post transplant. Urgent valve microscopy was highly suspicious of fungal growth, and antifungal therapy was instituted. Day 18 post-surgery the patient unexpectedly arrested. Post mortem findings showed ascending aortic perforation with multiple fungal lesions noted. Microscopy demonstrated aspergillus fumigatus invading the aortic wall. This is the first case report illustrating a dormant phase of aspergillus fumigatus endocarditis that was activated following surgery and immunosuppression leading to aortitis and subsequent perforation.

Key Words: Aspergillus fumigatus; Aortitis; Perforation; Aortic valve replacement; Liver transplantation