Intra-cardiac aspergilloma in a normally structured heart: A case report.

Fungal endocarditis is a relatively rare condition which mostly complicates those with intra-cardiac devices and those whose immune system is compromised. Here we present a 63-year-old diabetic man with two-weeks history of weakness and fatigue plus low-grade fever. Transesophageal echocardiography showed a mobile mass attached to the left coronary cusp of the aortic valve which protruded into the left ventricular (LV) outflow tract. Cardiac magnetic resonance further confirmed the presence of a large broad base 18 × 20 × 18 mm mass without gadolinium enhancement suggestive for fungal infection. Voriconazole was administered on the same day after which distal embolization of the mass to distal abdominal aorta ensued shortly. Echocardiography documented the disappearance of the mass from LV outflow tract. Vascular surgeon removed the mass from abdominal aorta immediately and pathology revealed the aspergilloma which was later confirmed by culture. After embolization the patient had become unstable and signs of septic shock occurred which ultimately led to his death in 72 h. Presence of infection in apparently normal cardiac chambers without presence of any intra-cardiac device is extremely rare and the presented case study reports such a scenario. Rapid initiation of anti-fungal agents and early surgery are of paramount importance in patient survival. < Cardiac aspergillosis is a rare condition and delayed diagnosis and treatment can be fatal. Cardiac imaging though helps differentiate the intra cardiac mass etiology, must not hinder early surgical removal especially when the location of the mass is critical.>.