Cardiac involvement by Aspergillus remains rare and most commonly occurs in the immunosuppressed and bone marrow transplant population.Reference Laszewski, Trigg, de Alarcon and Giller1 A 3-week-old neonate whom had suspicions of necrotising enterocolitis developed a severe leukocytosis (40,000) and haemodynamic instability 10 days after arterial switch operation for D-transposition of the great arteries. The patient did not respond to maximal medical therapies – ionotrops and antifungals – and thus required extracorporeal support. The echocardiogram initially showed flow in both coronary arteries; but 10 hours later, there was no longer left coronary blood flow, and electrocardiograms showed acute low voltage wide complexes. Within 6 hours, the patient suffered asystole with no evidence of any coronary artery blood flow.
At autopsy, there was necrotising fungal pneumonitis and massive angioinvasive Aspergillosis of the right and left coronary arteries, which had produced thrombosis, micro abscesses, and extensive infarction of the myocardium. Histological analysis with Gomori methenamine silver stain (figure at ×40 magnification) showed large calibre branching, non-septated hyphae consistent with Aspergillosis, which was confirmed with cultures.
Figure 1
Acknowledgements
Image analysis and processing courtesy of Wayne N. Christensen, MD and Peter Banks, MD of Levine Children’s Hospital, Department of Pathology, Charlotte, North Carolina, United States of America.
