Invasive nosocomial aspergillosis associated with heart failure and complete heart block following recovery from dengue shock syndrome.

OBJECTIVE: To report a case of invasive aspergillosis, associated with complete heart block and heart failure, in an immunocompetent child recovering from dengue shock syndrome. DESIGN: Case report and literature review. SETTING: Pediatric intensive care unit in a tertiary care center. PATIENT AND RESULTS: A 9-yr-old boy was admitted to our pediatric intensive care unit with dengue shock syndrome, for which he was successfully managed. During the recovery phase, the child developed recurrence of fever and signs of congestive heart failure. Thereafter, he developed complete heart block and died. Myocardial biopsy revealed myocarditis and invading fungal elements with branching septate hyphae suggestive of Aspergillus. A renal biopsy specimen also showed glomerular invasion with Aspergillus and patchy necrosis. This suggested the diagnosis of invasive aspergillosis. CONCLUSIONS: This case highlights an unusual manifestation of invasive aspergillosis in a critically ill immunocompetent child.