1
1240 BRIEF REPORTS FIGURE 1. Parasternal long-exis 2dimensional echocardiogram re- vealed a 1 X 1 cm vegetation on the mitral valve (arrow). Ao = aorta; LA = left atrium; LV = left ventrlcle. artery trifurcation. A 2-dimensional echocardiogram re- vealed a large vegetation of the anterior leaflet of the mitral valve (Fig. 1). Bilateral pulmonary infiltrates and hypoxemia developed and the patient died on the 15th hospital day. At necropsy, the myocardial walls of the 460g heart contained numerous white maSses (Fig. 2). The contained purulent material grew Aspergillua fumigatus. A large (1.2 cm) abscess was noted in the left ventricular wall behind the posterior mitral leaflet of the mitral valve, and it probably was the origin of the large septic embolus. Microscopic examination confirmed the presence of invasive masses of branching septate hyphae in the myocardial abscesses. Cardiac aspergillosis joins the list of rare infections that must be considered in patients with AIDS. Ne- cropsy evidence of fungal involvement of the heart has thus far not been described in these patients.lT2 One report described invasive pulmonary aspergillosis in a FIGURE 2. Gross specimen of the heart revealing abscesses involving the myocardium, mitral valve and papillary muscle (arrows). patient with AIDS.3 Aspergillar endocarditis is not as- sociated with intravenous drug use, and blood cultures are characteristically sterile.2*3-5Systemic embolism occurred in 4 of 13 patients in 1 study.6 Endocarditis was seriously considered in our patient only after the acute onset of hemiparesis. Absence of precordial mur- murs and of positive blood cultures had been falsely reassuring. 1. 2. 3. 4. 5. 6. References Relchd CM, O’Leary Al, Levens DL, Shell CR, Macher AM. Autopsy pathci y in tha acquired Immune deficiency syndrcma. Am J Pathcl 1983;l 2:357-382. “B Wdd~ K. Fbkbahsr Beckste~d JH. Auf W,AfDWSCB,BkWWddd W,DavldRL.SllWCkhEA. s findings in the acquired Immune deficiency syn- drorna. JAMA 1984?%152-1159 Jmm PO, Cohen i, Bitts Dn, &a J. Disserninatad histcplasmcsls, In- vasive puimcnary gillosis, 77 and other opportunistic Infections in a b mcsaxuai patient wl tha acquired immune deficiency syndrome. Sexually Transmitted Disease 1983;10:202-204. RuMnsteln E, Norl ER, Slmkrkoff MS, Holaman R, Rlshal JJ. Fungs endccarditis: anaiys s of 24 casas and review of tha literature. Medlclne T 1975;54:331-344. You119 RC, Sannatl JE, Vogel CL, Carbom PP. DaVlla VT. Aspargillosis: tha spectrum of tha disease in 98 tients. Medicina 1970;4%147-173. Welrh TJ, Hutchln GM, Bulkley k H, Mendelsohn 0. Fungai infections of the haart: analysis of 51 autopsy cases. Am J Cardlci 1980;45:357-388. Cryptococcal Myocardiiis in Acquired Immune Deficiency Syndrome WILLIAM LEWIS, MD JOSEPH LIPSICK, MD CARMINE CAMMAROSANO, BS Cardiac lesions are seen frequently at necropsy in pa- tients with acquired immune deficiency syndrome (AIDS).13 Most cardiac lesions in patients with AIDS are clinically silent. Of 44 patients with AIDS studied at autopsy at our medical center, 11 had major cardiac findings, including: nonbacterial thrombotic endocar- ditis (3 patients), metastatic Kaposi’s sarcoma (4 pa- From the Department of Pathology, UCLA School of Medicine, Center for the Health Sciences, Los Angeles, California 90024. Manuscript received November 26,198+ revlsed menu8cript received December 26, 1984, accepted December 31,1984. tie&) and fibrinous pericarditis (2 patients). Two pa- tients had acute myocarditis from Cryptococcus neo- formans with disseminated cryptococcal organisms in many noncardiac body organs also. Neither had clinical evidence of heart disease. Interstitial myocardial in- flammation was absent in both patients and myocyte necrosis was absent except in myoc$tes filled with organisms. Cryptococcal myocarditis is a rare myocardial fungal infection that is seen only in patient8 with immune suppres8ion.4>5 References 1. Sliver MA, Macher AM, Relcherl CM, Levem DL, Parllk JE, Longo DL, Roberls WC. Cardiac invoivemenl i’s samoma In acqulrad irnrmns daflclency syndrcrna (AIDS). Am 2. Relchert CM, O’Lea pathcicgy in acqulr d TJ, Levenn DL, Slmrell CR, Machef AM. Autopsy immune deficlancy syndrome. Am J Pathci 1983; 112:357-382. 3. Canunarwano C, Lewli W. Cardiac lesions in acquired Imrnuns deficiency s 4. x ndronw (AIDS): a postmortem study. JACC. In press. ulbr RVP, Collfns HS. Ths apparanca of oppcrtunlstic fungus infectlcns in a cancer hospital. Lab invest 1982;11:1035-1045. 5. Jenee I, Nauau E, SmHh P. Cryptococcows ofthehaart.BrHeartJ 1965;27:462-484.
