To the authors' knowledge, this is the first report of a life-threatening adverse event due to haemodynamic instability during anidulafungin administration. Cardiac toxicity associated with echinocandins has been described. Further studies seem to be mandatory to investigate this potential risk.
In a 57-year-old male with aortic valve stenosis and severe poststenotic dilation of the ascending aorta an aortic valve replacement and interposition of the dilated aortic segment with a Dacron prosthesis were carried out. Perioperative course was uneventful. Four months after dismission the patient presented with septic fever and recurrent arterial emboli. Histological evaluation of the thrombotic material found fungal masses of Aspergillus flavus. Although adequate antimycotic treatment was started immediately the patient died two days later. Postmortem examination revealed massive fungal infection of the Dacron prosthesis while the aortic allograft appeared free from infection. The symptoms of a fungal infection and possible diagnostic strategies are discussed.
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