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Published on: March 22, 2012
Emergency hemicolectomy for intestinal primary aspergillosis in acute myeloid leukemia
M Imola1, A M Mianulli, G Pasini
1Department of Oncology (Instituto Ondologico Romagnolo), General Surgery, Infermi Hospital, Rimini, Italy.
Abstract:
Intestinal aspergillosis is an infection with a very high death rate especially in leukemic patients. Here we describe a case of a 46 years old woman with acute myeloid leukemia (LAM M5) who developed intestinal primary aspergillosis. This patient was diagnosed with LAM M5 through bone marrow aspiration and bone biopsy in March 2004. Symptoms of the disease were slight persistent fever, weight loss, asthenia, anemia, thrombocytopenia,and leukocytosis with high number of blasts in peripheral blood. After induction chemotherapy with ICE (Ifosfamide, Carboplatin, Etoposide), she developed neutropenia and high fever without apparent infective foci. She was treated with empiric antibiotic therapy, nevertheless she developed an intense diarrhea and ileo-cecal distention. Diagnostic exams didn't show signs of a focal lesion. Despite the change in antibiotic treatment and the transfusions of granulocytes and blood cells, the patient developed extremely critical conditions with persistence of neutropenia and abdominal distention. A surgical treatment was decided at the time. We treated the patient with a two steps surgical procedure. The first step was a right abdominal ileostomy followed by improvement of general conditions and then the second step a right colectomy. The histological morphology confirmed necrotizing colitis with Aspergillus ife. At that time , treatment with voriconazole was started. The general conditions of the patient improved rapidly and we were able to treat the patient with other medical anti-leukemic therapies. The patient is now cured and in healthy state. We obtained a good clinical result as only in other few cases described in literature.
Insights
This case study details a successful treatment for intestinal aspergillosis, a rare and dangerous infection, in a patient with acute myeloid leukemia. Aggressive surgical intervention and antifungal therapy led to a full recovery.
Area of Science:
- Medical Mycology
- Hematology
- Gastroenterology
Background:
- Intestinal aspergillosis is a life-threatening infection, particularly in immunocompromised patients such as those with acute myeloid leukemia (AML).
- Early diagnosis and prompt management are critical for improving patient outcomes.
Observation:
- A 46-year-old female diagnosed with acute myeloid leukemia (LAM M5) developed primary intestinal aspergillosis following induction chemotherapy.
- The patient presented with neutropenia, persistent fever, severe diarrhea, and abdominal distention, initially without clear infective foci.
- Diagnostic imaging failed to reveal focal lesions, complicating the initial assessment and treatment.
Findings:
- Histopathological examination confirmed necrotizing colitis with Aspergillus hyphae, establishing the diagnosis of intestinal aspergillosis.
- A two-step surgical approach, including ileostomy and colectomy, combined with voriconazole treatment, led to rapid clinical improvement.
- The patient achieved a complete recovery and was able to resume further anti-leukemic therapies.
Implications:
- This case highlights the importance of considering invasive fungal infections in neutropenic patients with gastrointestinal symptoms, even without obvious focal findings.
- Aggressive surgical management combined with appropriate antifungal therapy can be highly effective in treating intestinal aspergillosis in leukemia patients.
- Successful treatment of intestinal aspergillosis can enable the continuation of essential anti-leukemic treatments, improving overall prognosis.
