Rupture and dissemination of a mycotic aneurysm caused by the Aspergillus fumigatus complex: A diagnostic challenge posed by a non‑sporulating isolate.

A 45-year-old male with a history of lumbar tuberculosis presented with a ruptured mycotic iliac artery aneurysm as the initial manifestation. Imaging demonstrated aneurysm rupture with pseudoaneurysm formation and concurrent disseminated lesions involving the vertebrae and soft tissues. Intraoperative specimens grew an Aspergillus fumigatus strain that exhibited highly atypical morphology: the colonies were albino‑like, slow‑growing, and non‑sporulating, differing markedly from the classic A. fumigatus phenotype. Peripheral blood metagenomic sequencing detected A. fumigatus, and the serum galactomannan antigen was markedly elevated. Molecular sequencing confirmed the isolate as A. fumigatus sequence type ST26 and identified the multidrug resistance‑associated gene ABCA. The final diagnosis was disseminated aspergillosis presenting as a ruptured mycotic iliac artery aneurysm, complicated by prosthetic graft infection and multiorgan dissemination. The patient received systemic antifungal therapy with voriconazole, along with adequate surgical drainage and debridement. Subsequently, his inflammatory markers declined gradually, and he was discharged on hospital day 58.