# Aspergillus aortitis in a patient presenting with bilateral acute lower limb ischemia

## TL;DR

A rare case of Aspergillus niger aortitis is reported in a patient with acute limb ischemia and a history of heart surgery.

## Contribution

This case highlights the diagnostic challenges and management of Aspergillus niger aortitis in post-cardiac surgery patients.

## Key findings

- The patient had an infected floating thrombus in the ascending aorta caused by Aspergillus niger.
- Symptoms were subtle and routine tests failed to detect the infection.
- Surgical intervention and antifungal therapy were critical for treatment.

## Abstract

Aspergillus niger aortitis is a rare but life-threatening fungal infection, typically affecting immunocompromised individuals. We present a unique case of a patient presenting with bilateral acute lower limb ischemia and a recent history of aortic valve repair. Despite the absence of typical infectious symptoms, further investigation revealed an infected floating thrombus in the ascending aorta. Subsequent surgical intervention and pathological analysis confirmed the presence of Aspergillus niger, a common environmental Mold, as the causative agent of aortitis. Our case highlights the challenges of diagnosing and managing Aspergillus niger aortitis, as symptoms can be subtle, and routine laboratory tests may not always detect the infection. Previous cardiac surgery is recognized as a significant risk factor for developing Aspergillus niger aortitis. This case report underscores the importance of considering Aspergillus niger aortitis in the differential diagnosis of patients with a history of cardiac surgery who present with unexplained embolic events, such as acute limb ischemia. Immediate recognition, decisive surgical intervention, and the initiation of appropriate antifungal therapy are imperative for maximizing patient outcomes in this complex condition.