Aortic bypass graft infection due to Aspergillus: report of a case and review.

Aspergillus is a rare cause of aortic graft infection. A recent case is reported and a review of seven other cases described in the literature since 1966 is presented. Infections of both thoracic and abdominal aortic grafts have been reported. Infection occurred from 5 weeks to 3 years after surgery. Underlying immunosuppressive disorders were not present. The most common presenting symptoms were back pain, fever, and embolic phenomena. Pseudoaneurysm of the vascular prosthesis with contiguous vertebral osteomyelitis was frequently seen. Blood cultures were always negative. Laboratory findings were nonspecific. The diagnosis was not anticipated in any case. Aspergillus was isolated in culture of specimens of the vertebral bone, excised graft, or peripheral emboli. Aspergillus fumigatus was the species most frequently isolated. Infection may have occurred intraoperatively as a result of contamination with airborne fungal spores. Optimal treatment included early removal of the graft with extraanatomical bypass plus prolonged antifungal therapy. Delayed surgical intervention and medical therapy alone were associated with high mortality rates. Aspergillar vascular infection should be suspected in patients with aortic grafts who develop persistent back pain, fever, or arterial embolization, and whose blood cultures are sterile.