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Disseminated aspergillosis complicating hepatic failure
Abstract:
Disseminated aspergillosis is not generally known as a complication of hepatic failure. Three patients with subacute hepatic necrosis died of clinically unrecognized disseminated aspergillosis. All of the patients had pulmonary aspergillosis and Aspergillus infections of the CNS. Focal neurologic deficits were clinically misconstrued as intracerebral hemorrhages caused by the coagulopathy of liver failure. Signs of invasive pulmonary aspergillosis were ascribed to refractory bacterial pneumonia. Each patient had a hospital course of longer than three weeks and each received treatment with corticosteroids and intravenous antibiotics. Invasive aspergillosis should be considered as a cause of refractory pneumonia and of new focal neurologic deficits in patients with hepatic failure.
Insights
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.