Aspergillus niger endocarditis complicating aortic tissue valve replacement.

4third caseofaspergillus infection onatissue valve andthe first ontheXenofic tissue valve. Casereport A 63yearoldmanunderwent aortic valve replacement with aXenofic tissue prosthesis forcalcific aortic stenosis and incompetence. Beforeoperation hehadhada small varicose ulcer overhisright ankle, culture swabsyielding Staphylococcus aureus andPseudomonas aeruginosa. Surgerywasdelayed until theulcer wasalmost healed. Antibiotic prophylaxis fortheoperation comprised cloxacillin and netilmicin, commencing withthe premedication andcontinuing for48hours after operation. Hemadeanuneventful recovery andwasdischarged onthe 11th postoperative daytaking nicoumalone. Fifty three daysafter operation hewasreadmitted with a twoweekhistory ofintermittent orthopnoea, night sweats, andgeneral malaise, heralded byanepisode ofsuperficial thrombophlebitis intheright leg. Hehadstarted totake oxytetracycline andampicillin sevendaysbefore. Hewas anaemic, mildly jaundiced, andfebrile (385°C), witha sinus tachycardia of100beats/min. Newaortic systolic and diastolic murmurswerepresent. Investigations showed the haemoglobin concentration tobe7-7g/dl (52%), thewhite cell count21 x 109/1, reticulocytes 10%,erythrocyte sedimentation rate82mm inonehour, ureaandelectrolytes normal, serumbilirubin 30,umol/l (1-8 mg/100ml), total proteins 6-2g/dl, albumin 2-8g/dl. Bloodcultures werenegative onfive occasions. Endocarditis wasdiagnosed andtreatment wasstarted withnetilmicin andflucloxacillin. Hiscondition worsened andthree dayslater hesuffered acerebrovascular accident causing aleft hemiparesis. Hediedfourdayslater. Necropsy showedvaricose eczemaonbothlegsanda smallulcer ontheright ankle; therewerenosplinter