Abstract
We describe a patient with invasive pulmonary aspergillosis (IPA) that was followed by infectious endocarditis. A 67 year-old man had been ventilated in the ICU because of Klebsiella pneumoniae that had spread hematogenically from a liver abscess. Transesophageal echocardiography (TEE) had revealed mild mitral valvular regurgitation, and no vegetation. Although the pneumonia improved, Aspergillus fumigatus was obtained from the sputum. Micafungin was started, but the respiratory status of the patient gradually became exacerbated. A chest CT revealed a new lesion, and the serum was positive for aspergillus antigen. The patient was diagnosed with IPA, and started on amphotericin B. However, amphotericin B had to be replaced with voriconazole due to renal damage. The respiratory status of the patient improved again, but weaning from the ventilator was difficult. Mitral regurgitation and a large mass on the mitral valve were revealed by TEE. Mitral regurgitation may have worsened the respiratory failure, and the fungal mass caused embolism in a remote organ. The mass was surgically removed and mitral valve plasty was performed. The patient was weaned from the ventilator and transfered to a ward.
