Endocarditis caused by Aspergillus fumigatus in a patient 9 months after COVID-19 infection recovery: a case report and review of the literature

J Med Case Rep. 2023 Dec 19;17(1):519. doi: 10.1186/s13256-023-04252-x.

Abstract

Background: Aspergillus spp. are among the fungal pathogens that can cause life-threatening infections in patients with a history of COVID-19.

Case presentation: We present the case of a 58-year-old Iranian woman with post-COVID-19 Aspergillus fumigatus endocarditis complicated by numerous thromboembolisms. She underwent mitral valve replacement surgery and multiple lower extremity embolectomies and was treated with voriconazole, which led to her final recovery.

Conclusions: Aspergillus endocarditis should be considered in any patient with suspected endocarditis who has a history of COVID-19 infection and does not respond to routine antibiotic and antifungal therapy, as COVID-19 interferes with proper immune function, and lack of underlying cardiac conditions and immunodeficiencies does not preclude the diagnosis. Culture and histopathological evaluation of vegetations and emboli, as well as PCR, can confirm the diagnosis. Early initiation of antifungal therapy and surgical removal of infected valves and emboli can improve prognosis in patients with Aspergillus endocarditis.

Keywords: Aspergillus; COVID-19; Endocarditis; Fungal infection; Opportunistic infection; Review.

Publication types

  • Review
  • Case Reports

MeSH terms

  • Antifungal Agents / therapeutic use
  • Aspergillosis* / complications
  • Aspergillosis* / diagnosis
  • Aspergillosis* / drug therapy
  • Aspergillus fumigatus
  • COVID-19* / complications
  • Endocarditis* / complications
  • Endocarditis* / diagnosis
  • Endocarditis* / drug therapy
  • Female
  • Humans
  • Iran
  • Middle Aged

Substances

  • Antifungal Agents