Aspergillus fumigatus as a clinical entity is difficult to diagnose. We present a case, which could facilitate diagnosis and management of the aforementioned disease. A 60-year-old man with
stent graft implantation in the descending aorta (6 years ago) presented with
fever, night sweats, and
weight loss over 5 months.
Leukocytosis and elevated
C-reactive protein were constantly spiking. Blood cultures were negative. Notably, the serum
immunoglobulin E (
IgE) level was strongly elevated (> 1,000 U/mL). Anamnestically, the patient suffered from a mild form of
atopic dermatitis and
bronchial asthma. The pulmonary status showed no abnormalities in the computed tomography image. Nonetheless, a chest scan revealed a suspected
abscess around the
stent graft of the descending aorta. Extra-anatomic ascending to descending aortic bypass (Gelsoft 22 mm, Vascutek, Juchinnan, Scotland, United Kingdom) was performed. Intraoperative samples revealed A. fumigatus. These findings were confirmed by polymerase chain reaction analysis.
Infection by A. fumigatus represents a diagnostic challenge because blood cultures are usually negative, but expeditious treatment is required to prevent occurrence of irreversible complications. A late graft
infection, possibly caused by A. fumigatus should be suspected in patients with implanted grafts, who suffer from unexplained, blood culture-negative
fever that does not respond to
antibiotics and who have a history of
dermatitis or
bronchial asthma with elevated
IgE antibodies.