Rupture and dissemination of a mycotic aneurysm caused by the Aspergillus fumigatus complex: A diagnostic challenge posed by a non‑sporulating isolate.
Weili Zhang, Ziyan Wei, Ya Liu et al.
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Case in brief
A 45-year-old male with a history of lumbar tuberculosis presented with a ruptured mycotic iliac artery aneurysm, which was the initial manifestation of disseminated aspergillosis. Imaging revealed aneurysm rupture and disseminated lesions in the vertebrae and soft tissues. Intraoperative cultures identified an atypical, non-sporulating strain of Aspergillus fumigatus. The patient was treated with voriconazole and surgical intervention, leading to a gradual decline in inflammatory markers and discharge on hospital day 58.
What made this case unusual
The Aspergillus fumigatus isolate exhibited atypical morphology, being albino-like, slow-growing, and non-sporulating, which is markedly different from the classic phenotype.
Diagnostic / clinical pearl
Clinicians should consider atypical presentations of Aspergillus infections, especially in patients with a history of immunocompromising conditions, as they may lead to significant diagnostic challenges.
Why it matters
This case highlights the importance of recognizing unusual fungal morphologies and the potential for severe complications, such as mycotic aneurysms, in patients with disseminated aspergillosis.