Late Onset of Aspergillus Aortitis Presenting as Femoral Artery Embolism Following Coronary Artery Bypass Graft Surgery

Abstract

Summary: Aspergillus sp. are ubiquitous mould infections and in most patients, the source is presumed to be air-borne infections during surgical procedures. Prevention of these infections requires special attention of ventilation systems in operating rooms. Post-operative aspergillosis occurs mainly in immunocompromised patients as well as those who receive corticosteroids temporarily. We report a case of a 71-year-old immunocompromised patient who developed multiple lower limb embolisms due to Aspergillus niger originating from an aortitis of the ascending aorta nine months following coronary artery bypass graft (CABG) surgery.

AspergillusAortitis: A Case with Near-Complete Occlusion of the Brachial Artery and Large Ascending Aortic Mycotic Pseudoaneurysm in an Immunocompetent Patient

“…6 Similarly, a case of Aspergillus niger aortitis presented as lower limb embolisms 9months after CABG. 7 Likewise, acute aortic occlusion from a saddle embolus originating from Aspergillus niger aortitis happened 4months after aortic valve replacement. 8 Another immunocompetent patient had embolization to the cerebral artery and cubital artery three years following CABG.…”

Invasive aspergillosis in the aortic arch with infectious Aspergillus lesions in pulmonary bullae

“…Aortic infection has also been described after cardiovascular surgery for valvular replacement [9] , [14] , [16] , aortocoronary bypass [9] , [12] , [13] , and replacement of the aorta for aortic dissection [15] . Aspergillus aortitis includes ascending aortic pseudoaneurysm [9] , aortic aspergilloma with supravalvular aortic stenosis [12] , and fungal ascending aortic aneurysm [14] .…”

“…Aortic infection caused by Aspergillus , including infection in immunocompromised hosts [1–8] and after cardiovascular surgery [8] , [9] , [12] , [13] , [14] , [15] , [16] , is a rare event. Aspergillus infection in immunocompromised hosts can occur in patients with hematologic disorders [1–5] , acquired immunodeficiency syndrome [6] , or immunosuppression following kidney or heart transplant [7] , [8] .…”

Aspergillus endocarditis presenting as acute right lower limb pain

“…Noordally SO et al reported a case of postoperative Aspergillus niger aortitis in an immunocompromised patient presenting as femoral artery embolism. 7 Rana M et al observed a very interesting case of embolic Aspergillus endophthalmitis from the hematogenous spread of Aspergillus infection from aortic root eight months following composite aortic root replacement in a young immunocompetent person for severe aortic regurgitation and dilated ascending aorta. 8 In the present case Aspergilli could have gained entry from the environment during surgery.…”