A case of invasive pulmonary aspergillosis with direct invasion of the mediastinum and the left atrium in an immunocompetent patient

Invasive mediastinal aspergillosis presenting as superior vena cava syndrome in an immunocompetent patient

Invasive aspergillosis (IA) is a disease of the immunocompromised with a predilection for the lungs, although dissemination to all organs is possible. Its diagnosis remains a challenge due to the absence of specific clinical manifestations and laboratory findings. In most cases, diagnosis is eventually made via invasive methods. It carries with it a high mortality due to late diagnosis and delayed treatment. Here, we report a fascinating case of a young, otherwise healthy, immunocompetent patient that presented to us with superior vena cava syndrome and a mediastinal mass. It was anticipated that a malignancy would be found on further workup but, in fact, what was eventually discovered was a case of IA. Our report accentuates the significance of including IA as a differential while diagnosing a mediastinal mass in an immunocompetent host as patient outcome is determined by timely diagnosis and treatment.

Fulminant Cryptococcus neoformans infection with fatal pericardial tamponade in a patient with chronic myelomonocytic leukaemia who was treated with ruxolitinib: Case report and review of fungal pericarditis

Cryptococcus neoformans is a saprophytic fungal pathogen that can cause serious illness in immune-compromised hosts and it presents with a wide variety of clinical symptoms. We present a fatal case of fulminant C. neoformans infection presenting as pericardial tamponade in a 71-year-old male with chronic myelomonocytic leukaemia undergoing chemotherapy with the JAK-STAT inhibitor ruxolitinib. We also review the published cases of fungal pericarditis/tamponade. In addition to illustrating an atypical presentation of C. neoformans, this case highlights the risk for opportunistic fungal infections in patients with haematological malignancies, especially the ones treated with small molecule kinase inhibitors.

Invasive Aspergillosis Involving the Mediastinum in an Immunocompetent Patient: A Case Report

We report a rare case of invasive pulmonary aspergillosis invading the mediastinum and the left atrium. A 38-year-old female was hospitalized for cough, shortness of breath and fever. She had a past medical history of tuberculosis. Computed tomography (CT) scans identified an ill-defined enhancing mediastinal soft tissue density mass encasing the heart and major vessels. The cardiac echocardiography showed global hypokinesia, low ejection fraction and a large echogenic density in the left atrium. The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which were stained with periodic Acid-Schiff and Gomori's methenamine silver. Despite the treatment with antifungal agents, the patient could not be saved. Invasive pulmonary aspergillosis, which involves the mediastinum and the heart, is very rare in immunocompetent patients.

Invasive aspergillosis presenting as an intracardiac mass in an immunocompetent host

Invasive aspergillosis is a severe fungal infection that primarily affects immunocompromised patients. We report a case of invasive aspergillosis presenting as a febrile respiratory infection with a cardiac mass in an immunocompetent patient. Excision of the intracardiac mass followed by histopathological examination confirmed the diagnosis. The patient was managed with voriconazole, to which he responded well. Rare occurrence of an intracardiac mass with systemic aspergillosis in an immunocompetent host is discussed in this case report.