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Published on: March 22, 2012
Delayed Diagnosis of a Diffuse Invasive Gastrointestinal Aspergillosis in an Immunocompetent Patient
S Guglielmetti1, C M Jaccard2, K Mühlethaler3
1Emergency Department, Bürgerspital Solothurn, Switzerland.
Abstract:
Invasive aspergillosis represents a clinical picture frequently associated with host's immunosuppression which usually involves a high morbidity and mortality. In general, the most frequent fungal entry is the lungs with secondary hematogenous dissemination, but there are other hypotheses like a gastrointestinal portal of entry. There are some rare publications of cases with invasive aspergillosis in immunocompetent patients. We present the case of an immunocompetent patient without any risk factors except for age, ICU stay, and surgical intervention, who developed a septic shock by invasive gastrointestinal aspergillosis as primary infection. Due to the unusualness of the case, despite all the measures taken, the results were obtained postmortem. We want to emphasize the need not to underestimate the possibility for an invasive aspergillosis in an immunocompetent patient. Not only pulmonary but also gastrointestinal aspergillosis should be taken into account in the differential diagnosis to avoid a delay of treatment.
Insights
Invasive aspergillosis can occur in immunocompetent patients, even without typical risk factors. This case highlights gastrointestinal aspergillosis as a primary infection, emphasizing its importance in differential diagnosis.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Critical Care Medicine
Background:
- Invasive aspergillosis (IA) is typically associated with severe immunosuppression, leading to high morbidity and mortality.
- Pulmonary infection is the most common route, with secondary hematogenous spread, but gastrointestinal (GI) entry is also hypothesized.
- IA in immunocompetent individuals is rare, with limited documented cases.
Observation:
- A case report of an immunocompetent patient, aged and recently discharged from the ICU after surgery, developed septic shock.
- The patient presented with primary invasive gastrointestinal aspergillosis.
- Despite comprehensive medical interventions, the outcome was fatal, with findings confirmed postmortem.
Findings:
- The patient's septic shock was attributed to invasive gastrointestinal aspergillosis, a primary infection.
- This case underscores that IA can manifest in immunocompetent hosts, challenging typical clinical presentations.
- Diagnostic delays may occur if GI aspergillosis is not considered in the differential diagnosis.
Implications:
- Clinicians should not underestimate the possibility of invasive aspergillosis in immunocompetent patients.
- Gastrointestinal aspergillosis should be considered in the differential diagnosis, alongside pulmonary routes.
- Early recognition and treatment of IA, regardless of host immune status, are crucial to improve patient outcomes.
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