Isolated Aspergillosis Myocardial Abscesses in a Liver-Transplant Patient

Cardiac abscess is an uncommon and fatal complication after transplantation. We report a case of an initially isolated aspergillosis myocardial abscess diagnosed by cardiac magnetic resonance imaging (CMRI). At that time, there was no other biological evidence or other extracardiac manifestations. A three-month course of dual antifungal therapy followed by a single antifungal therapy was empirically given. Six month after admission, Aspergillus fumigatus was isolated for the first time and the patient deceased from a disseminated aspergillosis. 1. Introduction Infections are commonly observed after solid-organ transplantation and generally require rapid and adequate therapy within this setting [1]. Although they seldom occur in cardiac locations, endocarditis is the main heart infection observed, whereas a cardiac abscess is rare. Concomitant clinical and/or biological abnormalities usually lead to etiologic diagnosis of a cardiac abscess. Herein, we report a case of an initially isolated cardiac abscess that occurred in a liver-transplant patient. Cardiac magnetic resonance imaging (CMRI) was found to be helpful in assessing the evolution of the abscess under empiric therapy. 2. Case Presentation A 68-year-old man underwent a first cadaveric orthotopic liver transplantation for hepatitis B virus and alcohol-induced cirrhosis that was complicated by hepatocellular carcinoma. After an induction therapy using antithymocyte globulins (ATG), his initial immunosuppressive therapy was based on tacrolimus, mycophenolate mofetil, and steroids. At day 11, because Aspergillus fumigatus was found in a systematic tracheal aspiration, a 21-day course of voriconazole was given. By day 60, he experienced a steroid-resistant acute rejection, which required ATG antirejection therapy. By day 78, he presented with isolated fever. C-reactive protein was 100？mg/L. Total lymphocyte count was 375/mm3. CD4-positive cell count was 60/mm3. Liver function tests were within the normal ranges. Blood-culture and urine-culture were negative for bacteria and fungi. Aspergillus antigenemia was negative. Cytomegalovirus DNAemia was negative. The bronchoalveolar lavage did not reveal the presence of any bacteria, virus, or fungi. In the absence of any identified cause of infection, he underwent a chest and abdominal CT scan, which showed an isolated rounded cardiac collection. Thus, a cardiac MRI was performed as soon as possible to enable diagnosis and close monitoring of the evolution of the cardiac lesion. The CMRI pointed out a 3？cm diameter collection within the epicardium and