Tumorlike Cardiac Fungal Mycetoma Caused by Scedosporium apiospermum Presenting as Symptomatic Ventricular Tachycardia

A 35-year-old man comes to the emergency department reporting dizziness, palpitations, and chest pain. A physical examination revealed a blood pressure of 70/50 mm Hg, faint peripheral pulses, and a regular cardiac rhythm. The ECG showed a regular widened QRS tachycardia (Figure 1A) that was electrically cardioverted with successful sinus rhythm reversion. He had no previous known cardiovascular pathologies, but was HIV-positive on antiretroviral therapy, with a history of cryptococcal and tuberculous meningitis (4 years before presentation). Viral load quantification was undetectable, and CD4 counting was 254 cells/μL. Impregnation with intravenous amiodarone was initiated. On transthoracic echocardiography, a tumorlike mass involving the right ventricle free wall and lateral tricuspid annulus was identified (Figure 1B). Initial cardiac MRI confirmed a large mass in the right ventricular free wall (Figure 1C, Movie I in the online-only Data Supplement) that demonstrated intense first-pass perfusion (Movie II in the online-only Data Supplement) and contrast uptake (Figure 1D …