Necrotizing colitis caused by systemic aspergillosis in a burn patient

The incidence of invasive fungal infections has continued to rise over the past three decades, especially in the immunocompromised and intensive care unit population. Candida species are the most common pathogen to cause such invasive infections. However, Aspergillus species are currently on the rise and constitute a much more aggressive and serious infection. All Aspergillus species cause a wide spectrum of diseases from colonization to hypersensitivity reactions. It can also cause chronic necrotizing infections leading to rapidly progressive angioinvasion, often resulting in death. Invasive Aspergillus infection almost always occurs in patients who are immunosuppressed. We report here a case of aspergillosis causing invasive systemic infection and mycotic colitis in a burn patient. The clinical presentation was one of septic shock with rapidly progressing dissemination leading to necrotizing colitis and eventual demise. Pathologic findings involved necrotizing enterocolitis with invasive Aspergillus hyphae. Given the rarity of this entity and usual progression to death in humans, proper diagnosis and treatment of such fungal infections are being investigated. Reports are reviewed, and possible mechanisms resulting in Aspergillus infection in this individual are discussed.