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Localized small-bowel infarction caused by Aspergillus during chemotherapy for acute myeloid leukemia: report of a
Megumu Enjoji1, Shunroh Ohtsukasa, Hiroto Nagano
1Department of Surgery, Musashino Red Cross Hospital, Musashino, Tokyo, Japan.
Abstract:
Aspergillosis is a common fungal infection in immunocompromised patients undergoing chemotherapy. The incidence of invasive fungal infection in these patients has increased dramatically in recent years. We report a case of small-bowel infarction caused by Aspergillus in a 48-year-old man who was receiving chemotherapy for acute myeloid leukemia. On day 20 after the start of chemotherapy, right lower abdominal pain and rebound tenderness developed, with a high fever. A contrast-enhanced computed tomography scan showed a semicircular perfusion defect in the ileum. Thus, we performed partial resection of the ileum with primary anastomosis. Macroscopically, the ileum had mucosal ulcerations. Microscopically, there was transmural necrosis with microperforation and Aspergillus invading necrotic tissue and blood vessels. The patient had an uneventful postoperative course and was discharged 14 days after the procedure. Intestinal aspergillosis is rare and associated with high mortality. Thus, it should be considered in the differential diagnosis of neutropenic patients with sudden abdominal pain and fever.
Insights
Invasive aspergillosis, a fungal infection, can cause rare but fatal intestinal complications in chemotherapy patients. This case highlights small-bowel infarction due to Aspergillus in a leukemia patient, emphasizing the need for prompt diagnosis.
Area of Science:
- Medicine
- Mycology
- Gastroenterology
Background:
- Aspergillosis is a significant opportunistic infection in immunocompromised individuals, particularly those on chemotherapy.
- The incidence of invasive fungal infections, including aspergillosis, has been rising in recent years.
Observation:
- A 48-year-old male undergoing chemotherapy for acute myeloid leukemia presented with acute abdominal pain and fever.
- Imaging revealed a perfusion defect in the ileum, leading to surgical resection.
- Microscopic examination confirmed Aspergillus invasion of necrotic tissue and blood vessels in the resected small bowel.
Findings:
- The patient experienced small-bowel infarction secondary to invasive Aspergillus infection.
- Histopathology demonstrated transmural necrosis and microperforation of the ileum.
- The patient recovered well post-surgery and was discharged after 14 days.
Implications:
- Intestinal aspergillosis is a rare but critical diagnosis in neutropenic patients presenting with acute abdominal symptoms.
- Early consideration of invasive fungal infection is crucial for timely intervention and improved patient outcomes.
- This case underscores the importance of a high index of suspicion for aspergillosis in immunocompromised patients with gastrointestinal distress.
