Shoar M G, Zomorodian K, Saadat F, Hashemi M J, Tarazoei B.
Fatal endocarditis due to Aspergillus flavus in Iran.
J Pak Med Assoc Jan ;54(9):485-6.

A 19-year old was admitted for fever, vomiting, anorexia, nausea, and chest pain. She had a history of Fallot`s Tetralogy, for which she underwent ventricular septal defect (VSD) surgery. She took gentamycin and penicillin with suspicion of bacterial endocarditis two weeks prior to hospitalization. Upon admission to the hospital, the patient`s complaints were severe dyspnea, chill, coughing, tachypnea and severe weight loss. Systolic and diastolic murmurs were discovered on physical examination but she had no sign of organomegaly, petechia, clubbing and edema. Peripheral blood examination disclosed anemia (Hb: 8 gr/dl, RBC: 2.9 x 10-6/µl, HCT: 28%) and leukocytosis (2S700/µ1). All of her six blood cultures were negative. In her echocardiography, verocoid vegetation was seen on her right ventricular under tricuspid valve. She underwent surgery to sequester mentioned vegetation over cortex patch, 9 days after admission. Drug therapy with amphotericin B (40 mg/day) and 5-flurocytosine (100 mg/kg/d) was initiated 1 day later. The examination of histological sections staining with periodic acid-Schiff (PAS) and Hematoxilin-Eosin (H&E) as well as wet mount (KOH 10%) preparation of samples indicated the branched, septated and dichotomous mycelia within the tissue. The remaining specimen was also cultured. The colonies grew rapidly, and their colour was yellowish-green. Slide cultures demonstrated septate, branched and hyaline hyphae with rough-walled conidiophores and radiated conidial heads. Based on these histological and mycological findings, Aspergillus flavus has been determined as causative agent of fungal endocaditis of this case. In spite of all intensivecare managements, the patient died on day 15 following brain emboli due to fungal endocarditis.

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