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Aspergillus Peritonitis complicating perforated appendicitis in adult acute leukemia
Abstract:
A 38-year-old male with terminal transferase positive acute lymphoblastic leukemia experienced fever, polymicrobial bacteremia, gastrointestinal bleeding, abdominal pain during induction therapy, and remission. Cecal perforation, Aspergillus peritonitis, and subsequent disseminated aspergillosis were successfully managed with colon resection, drainage, and antibiotic and antifungal therapy. Serologic tests for antibody to Aspergillus were repeatedly negative.
Insights
A patient with acute lymphoblastic leukemia developed serious Aspergillus infections, including peritonitis and disseminated disease, during treatment. Successful management involved surgery and antimicrobial therapies, despite negative antibody tests.
Area of Science:
- Oncology
- Infectious Diseases
- Gastroenterology
Background:
- Acute lymphoblastic leukemia (ALL) treatment can lead to severe complications.
- Induction chemotherapy for ALL increases susceptibility to opportunistic infections.
- Polymicrobial bacteremia and gastrointestinal bleeding are known risks during ALL therapy.
Observation:
- A 38-year-old male with TdT-positive ALL presented with fever, bacteremia, GI bleeding, and abdominal pain during induction.
- The patient developed cecal perforation and Aspergillus peritonitis, progressing to disseminated aspergillosis.
- Serologic tests for Aspergillus antibodies were consistently negative throughout the illness.
Findings:
- Successful management of invasive aspergillosis and cecal perforation was achieved.
- Treatment included colon resection, surgical drainage, and broad-spectrum antibiotic and antifungal agents.
- The case highlights successful outcomes despite diagnostic challenges posed by negative serology.
Implications:
- This case underscores the importance of prompt diagnosis and aggressive management of invasive fungal infections in immunocompromised patients.
- It suggests that negative Aspergillus antibody titers do not exclude invasive aspergillosis in critically ill, immunocompromised individuals.
- Multimodal treatment strategies, including surgical intervention and targeted antimicrobial therapy, are crucial for managing complex cases of invasive aspergillosis.