Paper # 020 Versión en Español Versión en Español

Chronic necrotizing pulmonary aspergilosis with cardiac invasion in an immunonocompromised patient


M. de la Vega, B. Báez, R. Camacho, J.L. Alfonso.

Department of Pathology. Hospital Nuestra Señora del Pino. Las Palmas de Gran Canaria. Spain.

Address: Hospital Nuestra Señora del Pino. C/ Ángel Guimera, 97
35004 Las Palmas de Gran Canaria. Spain.

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Introduction. Mycotic lung infections are specially aggressive in neutropenic patients, and they may give rise to invasive processes that almost invariably ends in patient's death. This is the case of Aspergillus infections (1). We present post-mortem findings of an immunocompromised patient with chronic necrotizing pulmonary aspergillosis and a peculiar type of cardiac invasion.

Case. 41 years old female diagnosed 13 years earlier of stage III B Hodgkin's disease, and treated with chemotherapy and radiotherapy. After 2 years she developed an pulmonary aspergillosis that was surgically treated (left lobectomy) and with amphotericin B. She was stable for the 8 following years, and after then she was admitted at hospital because a recurrence of aspergillosis that required an aggressive surgical treatment (total left neumonectomy). A few months later the patient got worse and developed an aspetic meningitis and a right hemiplegia. She died in septic shock.

Gross and histopathological study. The cause of death was a brain hemorrhage due to rupture of multiple mycotic aneurysms in Willis' artery polygon. The origin of the emboli was at the heart, but not at the cardiac valves. An excrescent, necrotic lesion located at the left auricle was in continuity, through the auricle wall, with the area of neumonectomy. Microscopically, septate hypha typical of Aspergillus were identified. We could find neither fungi in other organs nor recurrence of lymphoma.

Comments. We must insist in the aggressive behaviour of Aspergillus in immunocompromised patients, in the need of aggressive surgical and medical treatments (1) and, above all, in periodical examinations, given the difficult eradication of the fungus in these patients.


1.-Robinson LA, Reed EC, Galbraith TA, Alonso A, Moulton AL, Fleming WH. Pulmonary resection for invasive aspergillus infections in immunocompromised patients. J Thorac Cardiovasc Surg 1995;109:1182-1197

Key Words: chronic necrotizing pulmonary aspergillosis, Immunocompromised patient, Cardiac mycosis, Mycotic aneurysm

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