Resezione di una neoformazione atriale rara complicata da endocardite fungina in paziente in terapia immunosoppressiva

Nodules of mesothelial and monocytic cells (Mesothelial/Monocytic Incidental Cardiac Excresences; MICE) are rare cardiac lesions, non neoplastic, possibly reactive and in part derived from mesothelium. A 76 years old woman, treated with low dose of steroid and methotrexate for rheumatoid arthritis, underwent surgical excision of cardiac "MICE". Postoperative period was complicated with early and severe fungal endocarditis requiring reintervention. Two aspects are of interest: rarity of both cardiac pathologies and the possible relation to immunosuppressive therapy. Treatment of fungal endocarditis should be aggressive, overall survival is rather poor. Possibility to discontinue immunosuppressive treatment shoud be considered before cardiac surgery.