Aortic pseudoaneurysm due to Aspergillus fumigatus in a patient with post coronary artery bypass graft surgery

• In any patient with FUO post–cardiac surgery and negative cultures, especially with asplenia, Aspergillus should be considered. • Prompt surgical repair followed by two weeks of IV voriconazole and oral maintenance for one year, led to complete clinical resolution. • Long-term imaging and clinical monitoring post-treatment are critical for detecting recurrence. Aspergillus infection of the ascending aorta after coronary artery bypass grafting (CABG) is rare and generally portends a poor prognosis. This case presents a rare manifestation of aortic pseudoaneurysm caused by Aspergillus fumigatus following coronary artery bypass grafting (CABG) . A 60-year-old male, four months post-coronary artery bypass grafting (CABG), presented with a three-week history of fever of unknown origin. His medical history included splenectomy for idiopathic thrombocytopenic purpura (ITP).He was not taking any immunosupprepressive drugs. Lab tests showed elevated C-reactive protein but normal cultures and autoimmune markers. Imaging revealed a saccular pseudoaneurysm in the ascending aorta, confirmed by CT angiography. Surgical repair was performed, and tissue biopsy was morphologically consistent with Aspergillus species. PCR confirmed Aspergillus fumigatus. The patient was treated with voriconazole for one year, achieving complete clinical resolution. This case highlights a rare Aspergillus -related aortic pseudoaneurysm in a post-CABG patient with asplenia, emphasizing the importance of timely diagnosis and early surgical treatment and prolonged antifungal therapy. Aortic pseudoaneurysm, also called false aneurysm, is uncommon but potentially fatal complication, typically arising at sites of arterial wall damage ( Garisto et al., 2010 , Stolt et al., 2018 ).