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Fatal Fungal Peritonitis Caused by Aspergillus udagawae: An Autopsy Case Report

Kengo Nishino1, Takumi Kiwamoto1, Chio Sakai1

  • 1Department of Pulmonary Medicine, Institute of Medicine, University of Tsukuba, Japan.

Internal Medicine (Tokyo, Japan)
|February 11, 2026
PubMed

Insights

This case report details a fatal outcome of invasive pulmonary aspergillosis caused by multidrug-resistant Aspergillus udagawae, leading to fungal peritonitis. Molecular identification is crucial for treating refractory Aspergillus infections.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Pulmonology

Background:

  • Chronic progressive pulmonary aspergillosis can lead to invasive disease.
  • Multidrug-resistant Aspergillus species pose significant treatment challenges.
  • Disseminated fungal infections can affect multiple organ systems.

Purpose of the Study:

  • To report the first autopsy-proven case of fatal fungal peritonitis secondary to invasive pulmonary aspergillosis caused by Aspergillus udagawae.
  • To emphasize the importance of molecular identification in managing refractory Aspergillus infections.

Main Methods:

  • Case presentation of a 56-year-old male with chronic pulmonary aspergillosis.
  • Computed tomography (CT) scan for abdominal assessment.
  • Emergency surgery for peritonitis.
  • Autopsy for histopathological examination.
  • Genetic analysis for fungal identification.

Main Results:

  • The patient presented with acute abdominal pain, indicative of a ruptured intra-abdominal abscess and ascites.
  • Despite surgical intervention, the patient died due to peritonitis.
  • Autopsy revealed widespread fungal abscesses with direct and hematogenous spread from the lungs to the peritoneum.
  • Genetic analysis confirmed the causative agent as Aspergillus udagawae.

Conclusions:

  • This case highlights a rare but fatal complication of invasive pulmonary aspergillosis.
  • Molecular identification of Aspergillus species is critical for guiding appropriate antifungal therapy, especially in multidrug-resistant cases.
  • Early recognition and targeted treatment are essential to improve outcomes in invasive aspergillosis.
Keywords:
Aspergillus udagawaecryptic speciesfungal peritonitis

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