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Case report: retroperitoneal aspergilloma in a patient with rheumatoid arthritis presenting as malignant tumor
Risa Shinoki1, Teppei Takeshima1, Koichiro Horie2
1Department of Urology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.
Background:
Aspergillosis in patients with impaired immunity usually presents with invasive pulmonary infection and dissemination to a variety of organs via hematogenous spread. Aspergilloma in the retroperitoneal cavity is a rare disease with only a few cases reported in the literature. To the best of our knowledge, the present case of a retroperitoneal aspergilloma with no surgical history is only the second report in the literature.
Case Presentation:
A 65 year-old man, who had been receiving immunosuppressive treatment for rheumatoid arthritis with vasculitis for 9 years, was referred to the Urology Department with a retroperitoneal mass. This was confirmed by computed tomography performed during treatment for pulmonary aspergilloma. Because it was not possible to rule out malignant disease (e.g., liposarcoma), surgical exploration was performed. Pathological examination revealed aspergillus hyphae with fat necrosis, and retroperitoneal aspergilloma was diagnosed and appropriately treated. The tumor did not recur subsequently.
Conclusion:
Our present case emphasizes that pharmacological treatments for aspergilloma in the retroperitoneal cavity have poor drug transitivity, so the relative effectiveness of pharmacological response is not useful for differentiating retroperitoneal aspergilloma from malignant disease.
Insights
Retroperitoneal aspergilloma is a rare fungal infection in immunocompromised patients. Surgical exploration is crucial for diagnosis, as pharmacological treatments show poor drug penetration in this location.
Area of Science:
- Mycology
- Immunocompromised Host
- Surgical Pathology
Background:
- Aspergillosis commonly affects immunocompromised individuals, typically presenting as invasive pulmonary disease with potential for systemic dissemination.
- Retroperitoneal aspergilloma is an exceptionally rare clinical entity, with limited documented cases in medical literature.
- This report details the second known case of retroperitoneal aspergilloma occurring in a patient with no prior surgical history.
Observation:
- A 65-year-old male on long-term immunosuppressive therapy for rheumatoid arthritis presented with a retroperitoneal mass.
- Computed tomography confirmed a retroperitoneal mass during treatment for pulmonary aspergilloma, raising suspicion for malignancy.
- Surgical exploration was performed due to the inability to exclude malignancy, such as liposarcoma.
Findings:
- Pathological examination of the retroperitoneal mass revealed Aspergillus hyphae and associated fat necrosis.
- The diagnosis of retroperitoneal aspergilloma was established and the patient received appropriate treatment.
- No recurrence of the retroperitoneal aspergilloma was observed post-treatment.
Implications:
- The case highlights the diagnostic challenges in differentiating retroperitoneal aspergilloma from malignant retroperitoneal tumors.
- Pharmacological treatments for retroperitoneal aspergilloma are limited by poor drug transit, rendering response ineffective for differential diagnosis.
- Prompt surgical intervention and pathological confirmation are essential for managing this rare condition.
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