Aspergillus endocarditis in association with a false aortic aneurysm.

A 32-year-old man was admitted with an intracerebral hematoma and subsequently with bilateral femoral emboli five months after aortic valve replacement. Blood cultures for bacteria and fungi were negative but microscopy of the embolus revealed Aspergillus fumigatus. At operation a large false aneurysm of the ascending aorta and vegetations on the prosthetic aortic valve were found. Aspergillus endocarditis is diagnosed antemortem in only 23% of fatal aortic aneurysms: blood cultures are positive in only 8%. Clinically a large vessel embolus is characteristic, being present in 83% and microscopy and culture of such an embolus if present are vital investigations.