Aspergillus pancarditis and cardiac arrest during anesthesia.

Endocarditis, which may progress to myocardial and pericardial involvement (pancarditis), may be a slow, insidious disease with few clinical signs and symptoms. It may also be seen with clinical features that mimic other disease states, including renal failure. Clinical features common to endocarditis and renal failure include lassitude, anemia, embolic phenomena, heart murmurs, fever, and elevated white cell counts. We present a case of Aspergillus pancarditis associated with end stage nephrosclerosis, first, because it illustrates the difficulty in establishing the antemortern diagnosis of this type of endocarditis, and second, because repeated general anesthetics were associated with severe cardiovascular instability, including cardiac arrest. A relationship between intraanesthetic cardiovascular instability and mycotic pancarditis has not been previously reported.