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Invasive Primary Colonic Aspergillosis in the Immunocompetent Host without Classical Risk Factors.

Cha SA, Kim MH, Lim TS, Kim HH, Chang KY, Park HS, Kim HW, Wie SH, Jin DC - Yonsei Med. J. (2015)

Bottom Line: IA commonly occurs in the respiratory tract with isolated reports of aspergillosis infection in the nasal sinuses, central nervous system, skin, liver, and urinary tract.We describe a very rare case of IA involving the lower GI tract in the patient without classical risk factors that presented as multiple colon perforations and was successfully treated by surgery and antifungal treatment.We also review related literature and discuss the characteristics and risk factors of IA in the immunocompetent hosts without classical risk factors.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, School of Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea.

ABSTRACT
Invasive aspergillosis (IA), generally considered an opportunistic infection in immunocompromised hosts, is associated with high morbidity and mortality. IA commonly occurs in the respiratory tract with isolated reports of aspergillosis infection in the nasal sinuses, central nervous system, skin, liver, and urinary tract. Extra-pulmonary aspergillosis is usually observed in disseminated disease. To date, there are a few studies regarding primary and disseminated gastrointestinal (GI) aspergillosis in immunocompromised hosts. Only a few cases of primary GI aspergillosis in non-immunocompromised hosts have been reported; of these, almost all of them involved the upper GI tract. We describe a very rare case of IA involving the lower GI tract in the patient without classical risk factors that presented as multiple colon perforations and was successfully treated by surgery and antifungal treatment. We also review related literature and discuss the characteristics and risk factors of IA in the immunocompetent hosts without classical risk factors. This case that shows IA should be considered in critically ill patients, and that primary lower GI aspergillosis may also occur in the immunocompetent hosts without classical risk factors.

No MeSH data available.


Related in: MedlinePlus

(A) Chest X-ray showing multifocal patchy pneumonic consolidation in both lungs. (B) Chest computed tomography showing extensive multifocal ground glass opacities accompanying consolidation, suggestive of pneumonia with acute respiratory distress syndrome. (C) Chest X-ray shows regression of pneumonic consolidation on the 9th day of admission.
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Figure 1: (A) Chest X-ray showing multifocal patchy pneumonic consolidation in both lungs. (B) Chest computed tomography showing extensive multifocal ground glass opacities accompanying consolidation, suggestive of pneumonia with acute respiratory distress syndrome. (C) Chest X-ray shows regression of pneumonic consolidation on the 9th day of admission.

Mentions: A 47-year-old man visited the emergency room because of decreased mentality. He was diagnosed with diabetes mellitus (DM), but had not received regular treatment. His blood pressure was 60/30 mm Hg and body temperature was 38.5℃. Laboratory data showed white blood cell of 13.150×109/L, with a differential count of 90.7% neutrophils and 8.5% lymphocytes, hemoglobin of 14.3 g/dL, platelet count of 507×109/L, glucose levels of 443 mg/dL, blood urea nitrogen of 52.5 mg/dL, serum creatinine concentrations of 1.9 mg/dL, aspartate aminotransferase of 69 IU/L, alanine transaminase of 38 IU/L, sodium of 125.7 mmol/L, potassium of 5.4 mmol/L, C-reactive protein (CRP) levels of 19.42 mg/dL, ketone bodies in the blood 3 positive and HbA1c of 18.20%. Arterial blood gas analysis revealed a pH of 7.032, pCO2 of 21.8 mm Hg, pO2 of 83.3 mm Hg, and HCO3 of 5.8 mmol/L. Chest X-ray and computed tomography (CT) scans showed multiple consolidation and ground glass opacities in both lung fields (Fig. 1A and B). The patient was initially diagnosed with diabetic ketoacidosis as a result of severe pneumonia. An immediate hydration and insulin therapy were started, and dose-adjusted piperacillin and tazobactam sodium were also administered for pneumonia. The patient was admitted to the intensive care unit (ICU) for mechanical ventilator therapy. The ketoacidosis had improved with hydration and insulin therapy, but on the second day of hospitalization, diuretic-resistant pulmonary edema developed and continuous renal replacement therapy was started. Klebsiella pneumonia was identified in sputum cultures. After 8 days of treatment, the lung lesions had regressed (Fig. 1C). The patient was finally moved to the general ward. However, on the 5th day in the general ward, he started complaining of vague abdominal pain. His pain had aggravated with severe tenderness. An erect abdominal X-ray showed gaseous distention of small bowel loops with suspicious stepladder sign, suggesting mechanical obstruction (Fig. 2A). Subsequent abdominal CT suggested multiple perforation of the transverse colon with panperitonitis (Fig. 2B and C).


Invasive Primary Colonic Aspergillosis in the Immunocompetent Host without Classical Risk Factors.

Cha SA, Kim MH, Lim TS, Kim HH, Chang KY, Park HS, Kim HW, Wie SH, Jin DC - Yonsei Med. J. (2015)

(A) Chest X-ray showing multifocal patchy pneumonic consolidation in both lungs. (B) Chest computed tomography showing extensive multifocal ground glass opacities accompanying consolidation, suggestive of pneumonia with acute respiratory distress syndrome. (C) Chest X-ray shows regression of pneumonic consolidation on the 9th day of admission.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541682&req=5

Figure 1: (A) Chest X-ray showing multifocal patchy pneumonic consolidation in both lungs. (B) Chest computed tomography showing extensive multifocal ground glass opacities accompanying consolidation, suggestive of pneumonia with acute respiratory distress syndrome. (C) Chest X-ray shows regression of pneumonic consolidation on the 9th day of admission.
Mentions: A 47-year-old man visited the emergency room because of decreased mentality. He was diagnosed with diabetes mellitus (DM), but had not received regular treatment. His blood pressure was 60/30 mm Hg and body temperature was 38.5℃. Laboratory data showed white blood cell of 13.150×109/L, with a differential count of 90.7% neutrophils and 8.5% lymphocytes, hemoglobin of 14.3 g/dL, platelet count of 507×109/L, glucose levels of 443 mg/dL, blood urea nitrogen of 52.5 mg/dL, serum creatinine concentrations of 1.9 mg/dL, aspartate aminotransferase of 69 IU/L, alanine transaminase of 38 IU/L, sodium of 125.7 mmol/L, potassium of 5.4 mmol/L, C-reactive protein (CRP) levels of 19.42 mg/dL, ketone bodies in the blood 3 positive and HbA1c of 18.20%. Arterial blood gas analysis revealed a pH of 7.032, pCO2 of 21.8 mm Hg, pO2 of 83.3 mm Hg, and HCO3 of 5.8 mmol/L. Chest X-ray and computed tomography (CT) scans showed multiple consolidation and ground glass opacities in both lung fields (Fig. 1A and B). The patient was initially diagnosed with diabetic ketoacidosis as a result of severe pneumonia. An immediate hydration and insulin therapy were started, and dose-adjusted piperacillin and tazobactam sodium were also administered for pneumonia. The patient was admitted to the intensive care unit (ICU) for mechanical ventilator therapy. The ketoacidosis had improved with hydration and insulin therapy, but on the second day of hospitalization, diuretic-resistant pulmonary edema developed and continuous renal replacement therapy was started. Klebsiella pneumonia was identified in sputum cultures. After 8 days of treatment, the lung lesions had regressed (Fig. 1C). The patient was finally moved to the general ward. However, on the 5th day in the general ward, he started complaining of vague abdominal pain. His pain had aggravated with severe tenderness. An erect abdominal X-ray showed gaseous distention of small bowel loops with suspicious stepladder sign, suggesting mechanical obstruction (Fig. 2A). Subsequent abdominal CT suggested multiple perforation of the transverse colon with panperitonitis (Fig. 2B and C).

Bottom Line: IA commonly occurs in the respiratory tract with isolated reports of aspergillosis infection in the nasal sinuses, central nervous system, skin, liver, and urinary tract.We describe a very rare case of IA involving the lower GI tract in the patient without classical risk factors that presented as multiple colon perforations and was successfully treated by surgery and antifungal treatment.We also review related literature and discuss the characteristics and risk factors of IA in the immunocompetent hosts without classical risk factors.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, School of Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea.

ABSTRACT
Invasive aspergillosis (IA), generally considered an opportunistic infection in immunocompromised hosts, is associated with high morbidity and mortality. IA commonly occurs in the respiratory tract with isolated reports of aspergillosis infection in the nasal sinuses, central nervous system, skin, liver, and urinary tract. Extra-pulmonary aspergillosis is usually observed in disseminated disease. To date, there are a few studies regarding primary and disseminated gastrointestinal (GI) aspergillosis in immunocompromised hosts. Only a few cases of primary GI aspergillosis in non-immunocompromised hosts have been reported; of these, almost all of them involved the upper GI tract. We describe a very rare case of IA involving the lower GI tract in the patient without classical risk factors that presented as multiple colon perforations and was successfully treated by surgery and antifungal treatment. We also review related literature and discuss the characteristics and risk factors of IA in the immunocompetent hosts without classical risk factors. This case that shows IA should be considered in critically ill patients, and that primary lower GI aspergillosis may also occur in the immunocompetent hosts without classical risk factors.

No MeSH data available.


Related in: MedlinePlus