PRIMARY ASPERGILLUS ENDOCARDITIS - CASE-REPORT AND REVIEW OF THE INTERNATIONAL LITERATURE

The authors report a case of primary aspergillus endocarditis with end ophthalmitis and vertebral osteomyelitis. No underlying disease and no predisposing factors were found. Valve replacement plus combined anti fungal chemotherapy proved to be effective as the patient is asymptoma tic 18 months after the first symptoms. 48 cases of aspergillus endoca rditis, without prior cardiac surgery have been reported in the litera ture. Aspergillus endocarditis was valvular or mural. Extracardiac dis semination was common but endophthalmitis and osteomyelitis were infre quent. In 11 cases, the diagnosis was made by histologic examination o f embolectomy or ocular, skin biopsy tissue. All patients were febrile . Blood cultures showed no Aspergillus species. Clinical manifestation s of endocarditis were described in less than fifty per cent of cases. Echocardiographic visualization of vegetations was obtained in 5 case s. Many patients experienced embolic phenomena. Mortality from Aspergi llus endocarditis is extremely high (96%). Surgery is the main treatme nt, consisting of valve replacement. Antifungal chemotherapy should be combined. The proper duration and dosage and the combination of antif ungal drugs have not been clearly defined.