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Aspergillus endocarditis (AE) accounts for a-quarter of all fungal endocarditis, mainly in immunocompromised hosts prior to heart-valve surgery with high mortality, even with treatment. Herein, we report a rare case of AE in a diabetic 60-year-old woman with a history of redo mitral valve prosthesis suspecious of acute endocarditis. She underwent second redo surgical mitral valve replacement in combination with mechanical aortic valve replacement. Blood cultures were negative. The explanted valve and vegetation were subjected to identification. Grown colonies were identified as Aspergillus flavus, based on conventional and molecular methods. Despite the administration of liposomal amphotericin B and improvement in her general condition shortly after initiation of therapy, the patient passed away. As AE is a late consequence of redo prosthetic valve replacement, extended follow-up, early diagnosis, repeating valve-replacement surgeries, and timely selective antifungal treatments are warranted.

Rozita Jalalian,1 Tahereh Shokohi,2,3 Roghayeh Mirzakhani,4 Roya Ghasemian,5 Mohammad Taghi Hedayati,2,3 Sirus Ardalani,6 Soheil Azizi,7 Shamsi Kalhori,7 Firoozeh Kermani,4 Sabah Mayahi3 1Department of Cardiology, Mazandaran University of Medical Sciences, Sari, Iran; 2Invasive Fungi Research Centre (IFRC), Mazandaran University of Medical Sciences, Sari, Iran; 3Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; 4Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; 5Antimicrobial Resistance Research Center, and Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran; 6Department of Cardiac Surgery, Cardiovascular Research Center of Mazandaran Heart Center, Mazandaran University of Medical Sciences, Sari, Iran; 7Department of Pathology, Mazandaran Heart Center, Mazandaran University of Medical Sciences, Sari, IranCorrespondence: Tahereh ShokohiDepartment of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, IranTel +98 11 3354-3087Fax +98 11 3354-3248Email Shokohi.tahereh@gmail.comAbstract: Aspergillus endocarditis (AE) accounts for a-quarter of all fungal endocarditis, mainly in immunocompromised hosts prior to heart-valve surgery with high mortality, even with treatment. Herein, we report a rare case of AE in a diabetic 60-year-old woman with a history of redo mitral valve prosthesis suspecious of acute endocarditis. She underwent second redo surgical mitral valve replacement in combination with mechanical aortic valve replacement. Blood cultures were negative. The explanted valve and vegetation were subjected to identification. Grown colonies were identified as Aspergillus flavus, based on conventional and molecular methods. Despite the administration of liposomal amphotericin B and improvement in her general condition shortly after initiation of therapy, the patient passed away. As AE is a late consequence of redo prosthetic valve replacement, extended follow-up, early diagnosis, repeating valve-replacement surgeries, and timely selective antifungal treatments are warranted.Keywords: fungal endocarditis, Aspergillus, antifungal, prosthetic valve replacement