Fungal Ball in Ascending Aorta: Disseminated Histoplasmosis 20 Years After Aneurysm Repair.

Histoplasma capsulatum, an Ascomycetes fungus, is the responsible pathogen for histoplasmosis. Although often asymptomatic, around 1% of cases progress to disseminated infection. Endovascular graft infections with this fungus have been reported, particularly on abdominal aortic or aortofemoral bypass grafts. Timely antifungal therapy followed by appropriate surgical intervention is vital for a favorable outcome to be achieved. We describe a case involving a 73-year-old man in whom disseminated histoplasmosis developed 2 decades after his ascending aortic aneurysm repair. He presented with a fungal ball in the proximal ascending portion of the aorta. The patient was successfully treated with an aortic root replacement and hemiarch reconstruction.