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Invasive maxillary aspergillosis in a patient with systemic lupus erythematosus: Case report
Ishandono Dachlan1, Aditya Wicaksana1, Aditya Rifqi Fauzi1
1Plastic Reconstructive and Aesthetic Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.
Introduction:
Invasive aspergillosis (IA) is a fungal infection caused by Aspergillus species (spp.). Aspergillosis is the most common source of opportunistic fungal infection in humans. IA can cause serious complications related to high morbidity and mortality in immunocompromised patients.
Presentation Of Case:
We report a case of a 22-year-old female with a chief complaint of having a hole in the roof of her mouth. She was diagnosed with SLE in 2009. She had been consuming oral methylprednisolone ever since. In 2018, she experienced worsened symptoms and was hospitalized. She experienced swelling and bleeding of her gums and some of her teeth becoming loose and falling out, and then developing a hole in the roof of her mouth. Subsequently, she was treated with oral cyclophosphamide, oral mycophenolate sodium, and oral fluconazole. She was asked to stop taking oral methylprednisolone. In 2019, the palate biopsy was performed and showed Aspergillus spp. invading the palate. Afterward, the patient was referred to our clinic for defect closure. The patient was operated on for debridement and reconstruction of the defect. There was no recurrence of the defect or complications observed in the follow-up. The patient was satisfied with the surgical results.
Discussion:
IA is a destructive and potentially harmful opportunistic fungal infection and treatments with surgical interventions should be well-thought-out in immunocompromised patients.
Conclusion:
The management of IA are controlling any underlying diseases and surgical debridement or necrotomy. Generally, antifungal therapy and prompt surgical intervention are successful in managing invasive aspergillosis.
Insights
Invasive aspergillosis (IA) is a serious opportunistic fungal infection. Prompt surgical intervention and antifungal therapy are crucial for managing IA, especially in immunocompromised patients.
Area of Science:
- Mycology
- Immunocompromised Host Research
- Surgical Pathology
Background:
- Invasive aspergillosis (IA) is a severe opportunistic fungal infection caused by Aspergillus species.
- It poses significant morbidity and mortality risks, particularly in immunocompromised individuals.
- Systemic lupus erythematosus (SLE) and its immunosuppressive treatment are risk factors for IA.
Observation:
- A 22-year-old female with SLE presented with a palatal defect.
- She had a history of oral methylprednisolone use, later switched to cyclophosphamide and mycophenolate sodium.
- Palatal biopsy confirmed Aspergillus species invasion.
Findings:
- Surgical debridement and reconstruction successfully closed the palatal defect.
- The patient experienced no recurrence or complications post-surgery.
- Combined antifungal therapy and surgical intervention proved effective.
Implications:
- IA requires careful consideration of surgical interventions in immunocompromised patients.
- Management involves controlling underlying conditions and prompt surgical debridement.
- Multidisciplinary approach combining medical and surgical treatments is key for successful IA management.
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