PDF(Pubmed)
Abstract：
Aspergillus infectious endocarditis (IE) is a rare cause of culture-negative endocarditis. The main risk factors are severe immunosuppression and prosthetic heart valve. We describe a case of Aspergillus fumigatus IE on a native mitral valve in a patient with autoimmune hepatitis in remission while on low dose corticosteroids. The case is unique due to the patients\' low initial risk for invasive fungal disease, its clinical presentation and successful management with emergency surgery and antifungal therapy. After literature review we have not found a similar case report. The patient presented with right-sided eyesight deterioration due to endophthalmitis. Vitrectomy was performed and Aspergillus fumigatus grew on culture. IE on a native mitral valve was confirmed with echocardiography. The patient developed signs of acute heart failure soon after hospital admission and was diagnosed with several septic emboli (kidney, spleen, thumb, right common femoral artery). He was initially treated with surgical valve replacement, dual antifungal therapy with liposomal amphotericin B (LAmB) and voriconazole and vitrectomy, including intravitreal amphotericin B application. Long-term triazole therapy was not possible due to hepatotoxicity. The patient was maintained on intermittent LAmB for 12 months and is without signs of recurrence ten months after therapy was discontinued. Aspergillus can cause invasive infection in patients with autoimmune hepatitis on low dose corticosteroids. Early diagnosis followed by emergency surgical valve replacement and systemic antifungal therapy can improve prognosis. Additional studies are needed to evaluate alternative methods and duration of antimicrobial therapy following Aspergillus IE.
摘要：
曲霉感染性心内膜炎（IE）是培养阴性心内膜炎的罕见原因。主要危险因素是严重的免疫抑制和人工心脏瓣膜。我们描述了在低剂量皮质类固醇治疗中缓解的自身免疫性肝炎患者在天然二尖瓣上烟曲霉IE的情况。该病例是独一无二的，因为患者最初发生侵袭性真菌病的风险较低，其临床表现和急诊手术和抗真菌治疗的成功管理。经过文献回顾，我们没有发现类似的病例报告。患者由于眼内炎而出现右侧视力恶化。进行玻璃体切除术,并且烟曲霉在培养物中生长。用超声心动图证实了天然二尖瓣上的IE。患者入院后不久出现了急性心力衰竭的迹象，并被诊断出患有几例脓毒性栓子（肾，脾,脾拇指,右股总动脉）。他最初接受了手术瓣膜置换治疗，脂质体两性霉素B（LAmB）和伏立康唑的双重抗真菌治疗和玻璃体切除术，包括玻璃体内两性霉素B的应用。由于肝毒性，无法进行长期三唑治疗。患者在间歇性LAmB上维持12个月,并且在停止治疗后10个月没有复发迹象。曲霉菌可引起自身免疫性肝炎患者低剂量糖皮质激素的侵袭性感染。早期诊断后急诊手术瓣膜置换术和全身抗真菌治疗可改善预后。需要进一步的研究来评估曲霉菌IE后抗菌治疗的替代方法和持续时间。
