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Small-bowel infarction from disseminated aspergillosis
Christophe Trésallet1, Quang Nguyen-Thanh, Marie-Hélène Aubriot-Lorton
1Department of General Surgery, Pitié Hospital, Paris, France.
Diseases of the Colon and Rectum
|October 16, 2004
Summary
Invasive aspergillosis can be fatal in neutropenic patients. Early diagnosis using Aspergillus antigenemia and imaging is crucial for timely antifungal therapy and improved outcomes.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Gastroenterology
Background:
- Disseminated invasive aspergillosis poses a significant mortality risk in neutropenic patients.
- Nonspecific early symptoms complicate timely diagnosis and intervention.
- Novel diagnostic tools are needed to facilitate early surgical management when indicated.
Observation:
- A neutropenic patient presented with acute abdomen, characterized by diffuse small bowel distention and thickened distal ileum on CT.
- Emergency surgery revealed distal ileum necrosis and invasion by Aspergillus fumigatus.
- Postoperative course complicated by Clostridium difficile infection; Aspergillus antigenemia was detected.
Findings:
- Serum Aspergillus antigen was positive, but CT scans ruled out pulmonary or central nervous system aspergillosis.
- Histopathology confirmed Aspergillus fumigatus invasion in the resected ileum.
- The case highlights gastrointestinal tract as a potential primary site for invasive aspergillosis.
Implications:
- Consider invasive aspergillosis in neutropenic patients with abdominal pain, distention, and fever.
- Serial Aspergillus antigen testing, imaging (CT), and colonoscopy with biopsies are recommended for diagnosis.
- Early diagnosis enables prompt antifungal therapy, potentially improving survival rates.