A renal transplant recipient with a pulmonic valve mass

Cardiovasc Pathol. 2025 Sep-Oct:78:107745. doi: 10.1016/j.carpath.2025.107745. Epub 2025 Jun 13.

Abstract

A 43-year-old female with a renal transplant presented with fatigue, dyspnea, anemia, and thrombocytopenia. Chest CT revealed pulmonary nodules, and transthoracic echocardiography identified a large, multi-lobulated, multi-cystic mass attached to the pulmonic valve. Pathology demonstrated fungal hyphae, and bronchoalveolar lavage (BAL) fluid grew Aspergillus fumigatus, with a serum Aspergillus galactomannan (GM) antigen index of 1.95. The pulmonic valve was excised and a bioprosthetic valve was inserted. The patient was treated with voriconazole. Pulmonic valve Aspergillus endocarditis (AE) is a rare condition associated with high mortality. Given the rising number of transplant recipients, heightened clinical vigilance is warranted in this population.

Keywords: Aspergillosis; Blood culture-negative endocarditis; Infective endocarditis; Invasive Aspergillosis; Pulmonic valve endocarditis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antifungal Agents / therapeutic use
  • Aspergillosis* / diagnosis
  • Aspergillosis* / microbiology
  • Aspergillus fumigatus* / isolation & purification
  • Endocarditis* / diagnosis
  • Endocarditis* / microbiology
  • Female
  • Heart Valve Prosthesis Implantation / instrumentation
  • Humans
  • Kidney Transplantation* / adverse effects
  • Pulmonary Valve* / diagnostic imaging
  • Pulmonary Valve* / microbiology
  • Pulmonary Valve* / pathology
  • Pulmonary Valve* / surgery
  • Treatment Outcome
  • Voriconazole / therapeutic use

Substances

  • Antifungal Agents
  • Voriconazole