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Locally invasive aspergillosis of the bowel
W F Marterre1, A T Mong, A R Pulito
1Department of Surgery, University of Kentucky Medical Center, Lexington 40536-0084.
Abstract:
Locally invasive aspergillosis of the bowel and peritoneal cavity is a rare complication of immunosuppression, broad-spectrum antibiotic therapy, and corticosteroid administration. We present the case of a 9-year-old boy with acute lymphocytic leukemia who presented with a small bowel obstruction. Surgical treatment of the aspergillosis required multiple aggressive resections of all involved bowel segments. Parenteral nutrition and intravenous Amphotericin B and 5-Fluorocytosine therapy were also instituted. Achievement of a hematologic remission is another prerequisite for cure.
Insights
Locally invasive aspergillosis in children is rare but serious, often occurring in leukemia patients. Aggressive surgical resection and antifungal therapy are crucial for managing this severe bowel complication.
Area of Science:
- Medical Mycology
- Pediatric Oncology
- Gastroenterology
Background:
- Locally invasive aspergillosis (LIA) is a rare but life-threatening fungal infection.
- It primarily affects immunocompromised individuals, including those with hematologic malignancies.
- Risk factors include immunosuppression, broad-spectrum antibiotics, and corticosteroid use.
Observation:
- A 9-year-old boy with acute lymphocytic leukemia (ALL) presented with symptoms of small bowel obstruction.
- Diagnostic evaluation revealed invasive aspergillosis affecting the bowel and peritoneal cavity.
- The patient required extensive surgical intervention.
Findings:
- Multiple aggressive resections of the involved bowel segments were necessary for treatment.
- The patient received parenteral nutrition and intravenous antifungal agents, including Amphotericin B and 5-Fluorocytosine.
- Hematologic remission of acute lymphocytic leukemia was identified as a prerequisite for successful cure.
Implications:
- This case highlights the critical need for prompt diagnosis and aggressive management of invasive aspergillosis in pediatric leukemia patients.
- Multidisciplinary care involving surgery, infectious diseases, and oncology is essential.
- Early recognition and treatment can improve outcomes for this rare but devastating complication.