The U.S. Centers for Disease Control and Prevention defines Aspergillus mediastinitis as the presence of a positive culture result from a mediastinal sample, plus one of the following: 1) fever higher than 38 °C, or 2) chest pain or sternal instability with purulent effusion in the mediastinum or positive culture results from surgically obtained samples or blood.1 Of all cardiothoracic procedures, orthotopic heart transplantation (OHT) is associated with the highest risk of mediastinitis (including bacterial and fungal), with infection rates of 2.5% to 6%.3 A review of the literature reveals only 3 cases in which Aspergillus mediastinitis occurred after OHT; all 3 cases involved A. fumigatus. We describe what we believe to be the first case of Aspergillus calidoustus mediastinitis after OHT. Case ReportA 55-year-old woman was admitted for OHT. Her medical history was notable for ischemic cardiomyopathy, as well as for hypertension, dyslipidemia, coronary artery disease, myocardial infarction, ventricular tachycardia, paroxysmal atrial fibrillation, and chronic kidney disease. Her surgical history included implantation of a left ventricular assist device (LVAD), resection of a left ventricular aneurysm, and implantation of a biventricular defibrillator. She had no history of infectious sequelae with her LVAD. During the OHT procedure, the patient was coagulopathic and needed several units of different blood products. Her chest was temporarily closed at the end of the operation and was permanently closed 3 days later.Postoperatively, she had prolonged respiratory and renal failure that necessitated ventilator support, hemodialysis, and inotropic and vasopressor support. Despite the new heart, she also needed further circulatory support, including an intra-aortic balloon pump. Two weeks postoperatively, she underwent a tracheostomy. Five weeks postoperatively, she developed fever with an elevated white blood cell count. Physical examination revealed tenderness, erythema, and sternal wound drainage. A computed tomographic scan revealed a mediastinal fluid collection and thereby confirmed the diagnosis. Surgical drainage of the fluid and aggressive débridement of the infected sternum were performed. During débridement, we locally irrigated the infected tis-