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Disseminated aspergillosis complicating hepatic failure
Archives of Internal Medicine
|June 1, 1983
Summary
Disseminated aspergillosis, a fungal infection, can be a fatal complication in patients with liver failure. Clinicians should consider invasive aspergillosis in patients with hepatic failure presenting with refractory pneumonia or new neurological deficits.
Area of Science:
- Medical Mycology
- Hepatology
- Neurology
Background:
- Disseminated aspergillosis is rarely associated with hepatic failure.
- Subacute hepatic necrosis can predispose patients to invasive fungal infections.
- The clinical presentation of aspergillosis may mimic other complications of liver disease.
Observation:
- Three patients with subacute hepatic necrosis developed disseminated aspergillosis.
- Pulmonary and central nervous system (CNS) involvement by Aspergillus were noted in all patients.
- Neurologic deficits were misinterpreted as intracranial hemorrhages due to coagulopathy.
Findings:
- Invasive pulmonary aspergillosis was misdiagnosed as refractory bacterial pneumonia.
- Disseminated aspergillosis was clinically unrecognized in all three cases.
- Patients received prolonged corticosteroid and antibiotic therapy.
Implications:
- Invasive aspergillosis should be considered in the differential diagnosis of refractory pneumonia in hepatic failure.
- New focal neurologic deficits in patients with liver failure may indicate Aspergillus CNS infection.
- Early recognition and treatment of invasive aspergillosis are crucial in immunocompromised patients with hepatic failure.