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Postmortem Diagnosis of Invasive Disseminated Aspergillosis After Tongue Piercing
Stefano Tambuzzi1, Guendalina Gentile, Salvatore Andreola
1From the Laboratorio di Istopatologia Forense e Microbiologia Medico Legale-Sezione di Medicina Legale e delle Assicurazioni-Dipartimento di Scienze Biomediche per la Salute-Università degli Studi di Milano Milano, Italy.
Abstract:
Severe fungal infections caused by highly invasive fungi such as Aspergillus are not easy to diagnose and often have a poor prognosis. In these cases, the nonspecific symptoms may make clinical diagnosis challenging, and consequently, the autopsy and postmortem histological investigations acquire a crucial role. We report the case of a young man in good health who died of septic shock 3 weeks after having had a tongue piercing. Intravitam investigations did not identify the etiology of the rapidly fatal infectious condition. The autopsy revealed flaccid organs of uniformly diminished consistency with abscesses and granulomatous foci with central necrosis. Histological examination showed the presence of septate mycotic hyphae, with a dichotomous 45-degree bifurcation, typical for Aspergillus , in all the examined organs, including the tongue. The molecular identification confirmed the presence of Aspergillus fumigatus. The observed macroscopic framework and the laboratory findings made it possible to diagnose pseudomembranous invasive tracheobronchial aspergillosis and to attribute the death to fatal invasive disseminated aspergillosis. The consistency and concordance of all the findings in our possession led us to suspect the practice of piercing as the triggering cause of the man's pathology.
Insights
A young man died from invasive disseminated aspergillosis, a severe fungal infection, following a tongue piercing. Autopsy revealed Aspergillus fumigatus, suggesting the piercing as a potential trigger for the fatal condition.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Forensic Pathology
Background:
- Severe invasive fungal infections, particularly those caused by Aspergillus species, present diagnostic challenges and poor prognoses.
- Nonspecific symptoms in severe infections can complicate clinical diagnosis, underscoring the importance of postmortem investigations.
Observation:
- A case report of a previously healthy young man who died of septic shock three weeks after tongue piercing.
- Autopsy revealed disseminated abscesses and granulomatous foci with central necrosis in multiple organs.
- Histological and molecular identification confirmed Aspergillus fumigatus in all examined organs, including the tongue.
Findings:
- Diagnosis of pseudomembranous invasive tracheobronchial aspergillosis and fatal invasive disseminated aspergillosis.
- The presence of Aspergillus fumigatus hyphae in the tongue suggested a potential inoculation site.
- The findings strongly implicated tongue piercing as the triggering event for the disseminated fungal infection.
Implications:
- Highlights the potential risks associated with body piercings in relation to invasive fungal infections.
- Emphasizes the need for thorough postmortem examinations to determine the etiology of unexplained fatal conditions.
- Suggests a possible route of fungal dissemination through practices like tongue piercing, particularly with immunocompromised or susceptible individuals.
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