Fibrosing mediastinitis due to Aspergillus with dominant cardiac involvement: report of two autopsy cases with review of literature

Fibrosing mediastinitis (FM) is a rare condition characterized by extensive proliferation of fibrous tissue in the mediastinum resulting in mass like lesion. Histoplasma and Mycobacterium tuberculosis are the common infective causes of fibrosing mediastinitis, but Aspergillus infection is an extremely rare cause. Fibrosing mediastinitis due to Aspergillus usually occurs following Aspergillus bronchopneumonia. Cardiac involvement due to Aspergillus-related fibrosing mediastinitis is extremely rare in immune-competent individuals and occurs following some intervention or as a part of disseminated systemic fungal infection. Here, we report two cases of Aspergillus FM with dominant cardiac involvement in immune-competent patients. Both cases presented with large mediastinal mass and large vegetation in the left atrium. Autopsy findings showed the granulomatous Aspergillus mediastinitis and extension into the heart with associated fibrosis. One case was proven to be due to Aspergillus flavus by fungal genomic sequencing. To the best of our knowledge, this is the first report of Aspergillus FM with pancarditis.