Aspergillus flavus endocarditis and meningitis in a child with marfan syndrome

Azam   Fattahi; Shirin  Sayyahfar; Ensieh  Lotfali; Reza  Ghasemi; Hojjat  Mortezaeian

doi:10.18502/cmm.6.4.5441

Azam Fattahi Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
Shirin Sayyahfar Department of Pediatrics, Division of Pediatric Infectious Diseases, Ali Asghar Children Hospital, Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
Ensieh Lotfali Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Reza Ghasemi Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Hojjat Mortezaeian Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/cmm.6.4.5441

Keywords: Aspergillus flavus Endocarditis Fluconazole Meningitis

Abstract

Background and Purpose: Aspergillus species are implicated as the etiology of approximately 26% of endocarditis cases. Central nervous system aspergillosis is a life-threatening condition that has a mortality rate of 80%.

Case report: Herein, we report a four– year- old female who was admitted to the pediatric infectious ward due to a fever of unknown origin in January 2020. She was a known case of Marfan syndrome with a family history of this syndrome in her mother. The species was identified using (PCR) and the antifungal susceptibility test was performed using four antifungal agents based on the Clinical and Laboratory Standards Institute M38 3rd edition. Fluconazole-resistant Aspergillus flavus was identified to be responsible for endocarditis and meningitis as well as fever of unknown origin.

Conclusion: The clinicians should be aware and consider fungal endocarditis in blood culture-negative endocarditis even in patients with no significant risk factor when antibiotic therapy fails.