SHM Converge Scientific Abstract ePoster Gallery-Curious Case of Curvularia: Aortic Graft Infection by Curvularia Papendorfii

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A 67-year-old man with a history of atrial fibrillation, coronary artery bypass grafting, aortic stenosis treated with bioprosthetic valve replacement, and recent ascending aortic aneurysm graft repair presented with sudden bilateral vision loss. Inpatient evaluation revealed bilateral panuveitis and retinal dysfunction. Imaging showed splenic wedge infarcts, raising concern for thromboembolic disease, and CT angiography of the chest identified a 2.8 x 1.5 cm hypodensity along the edge of the ascending aortic graft, concerning for either infected aortitis or thrombus.<br /><br />He was transferred to the cardiac ICU, where cultures and serologic studies were repeatedly negative, though eosinophilia persisted. He was anticoagulated with warfarin, but his hospital course worsened with severe altered mental status and bilateral temporo-occipital hemorrhages, prompting transfer to the neuro ICU. After discussions with the care team and medical power of attorney, the family chose comfort-focused care, and he was discharged home with hospice.<br /><br />A Karius plasma microbial cell-free DNA test later identified Curvularia papendorfii and Curvularia lunata, supporting a rare fungal graft infection. Curvularia is a dematiaceous (“black”) fungus usually found in soil and plant debris and more commonly causes corneal, cutaneous, or subcutaneous infections, often in immunocompetent patients. Disseminated disease is uncommon and is usually seen in immunocompromised hosts.<br /><br />This case is notable because Curvularia papendorfii had not previously been documented as causing an aortic graft infection. It highlights the importance of considering rare fungal pathogens in postoperative vascular graft infections, especially when routine cultures are negative and imaging suggests graft involvement.

Asset Subtitle

Stephanie Batch

Meta Tag

Author List Matthew Brigmon, Stephanie Batch

Category Clinical Vignettes

Concept Aortic Graft Infection

Concept Fungal infection

Concept Curvularia

Concept Curvularia papendorfii

Concept Dematiaceous fungus

Distinguished Non-Finalist

Presenter Organization University of Texas Health Science Center San Antonio

Presenting Author Stephanie Batch

Track Adult

Keywords

Curvularia papendorfii

aortic graft infection

fungal endocarditis

bilateral vision loss

panuveitis

retinal dysfunction

splenic infarcts

eosinophilia

infected aortitis

plasma microbial cell-free DNA

Aortic Graft Infection

Fungal infection

Curvularia

Curvularia papendorfii

Dematiaceous fungus