Aspergillus prosthetic valve endocarditis complicated by intracranial haemorrhage

A 73-year-old male developed early prosthetic aortic valve endocarditis complicated by haemorrhagic cerebral lesions 45 days after tissue valve replacement. Transesophageal echocardiography revealed bulky vegetations and an annular abscess. Urgent surgical valve replacement with extensive debridement was performed, while broad-spectrum antifungal therapy was initiated. Aspergillus terreus was subsequently confirmed. Postoperatively, the patient experienced acute hydrocephalus, subarachnoid haemorrhage, and recurrent vegetations, ultimately precluding further surgery. He died on postoperative day 57. This case highlights the diagnostic and therapeutic challenges of early fungal prosthetic endocarditis with intracranial haemorrhage, emphasizing individualized management by multidisciplinary teams and the high mortality associated with Aspergillus infections.