A Case Report of Invasive Aspergillosis Encasing the Pulmonary Valve: A Rare Cause of Infective Endocarditis

Abstract Background Aspergillus endocarditis is a rare cause of infective endocarditis and requires high index of suspicion for diagnosis. Case Summary We describe a case of a 50-year-old man with history of metastatic thymoma on immunosuppression (gemcitabine and capecitabine) who presented with progressive dyspnoea. Echocardiography and CT of chest showed filling defect in the pulmonary artery. The initial differential diagnosis were of pulmonary embolism and metastatic disease. The mass was subsequently excised, which revealed a diagnosis of Aspergillus endocarditis of the pulmonary valve. Unfortunately, he passed away despite medical treatment with antifungal therapy after surgery. Discussion Aspergillus endocarditis should be suspected in immunosuppressed hosts with negative blood cultures and large vegetations on echocardiography. Diagnosis is made by tissue histology but may be difficult or delayed. Optimal treatment involves aggressive surgical debridement and prolonged antifungal therapy; prognosis is poor with high mortality.