We report the case of a 24-year-old woman with a history of bicuspid aortic valve stenosis who had undergone commissurotomy at the age of 5 years. At the age of 22 years, the aortic valve was replaced with a mechanical prosthesis and the ascending aorta with a Dacron graft. At one year after this surgery, she came to our emergency department with fever peaks of 38.5 ºC and intense epigastric pain; she was hemodynamically stable, with no signs of peripheral hypoperfusion.
Figures: Aspergillus vegetations: small filling defects are observed in the lumen of the supracoronary tube graft, adhered to its wall and suggesting thrombi. A progressive increase is observed in the size and number of filling defects in the lumen of the supracoronary tube graft, with almost total occlusion (arrows).
Very few cases of vascular prosthesis infection by Aspergillus have been reported, mainly in immunocompetent patients and often caused by contamination of the prosthesis during surgery. They are associated with a high mortality despite aggressive medical and surgical treatment.
The differential diagnosis of all patients with an aortic graft whose CT scan shows images of thrombosis on the graft walls should include vegetations caused by Aspergillus infection, specially relevant if patients have unexplained fever and if the intra-prosthetic hypodense material increases despite appropriate anticoagulant treatment. Early diagnosis may improve the survival of patients with this disease, which has a very high mortality rate.
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