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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

Periodic acid-Schiff (A) and Grocott's methenamine silver (B) stains (original magnification ×400) of resected colon specimen show septated fungal hyphae with acute angle branching, morphologically consistent with aspergillus species.
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Figure 3: Periodic acid-Schiff (A) and Grocott's methenamine silver (B) stains (original magnification ×400) of resected colon specimen show septated fungal hyphae with acute angle branching, morphologically consistent with aspergillus species.

Mentions: An emergency laparotomy was performed. Necrotic intestines were observed from the distal ascending colon to the proximal transverse colon. Necrotic portions were resected and the Periodic Acid Schiff and Grocott's methenamine silver staining of the resected specimen showed septated fungal hyphae with acute angle branching, suggesting aspergillus species (Fig. 3). The patient was finally diagnosed with colonic IA. Intravenous liposomal amphotericin-B (3 mg/kg/day) was additionally administered for 35 days. He was discharged with oral voriconazole to treat his reported remaining, abdominal discomfort and mildly elevated CRP levels. Voriconazole was discontinued at a follow-up visit to the outpatient department 2 weeks after discharge when his abdominal discomfort had relieved and CRP levels normalized.


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)

Periodic acid-Schiff (A) and Grocott's methenamine silver (B) stains (original magnification ×400) of resected colon specimen show septated fungal hyphae with acute angle branching, morphologically consistent with aspergillus species.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Periodic acid-Schiff (A) and Grocott's methenamine silver (B) stains (original magnification ×400) of resected colon specimen show septated fungal hyphae with acute angle branching, morphologically consistent with aspergillus species.
Mentions: An emergency laparotomy was performed. Necrotic intestines were observed from the distal ascending colon to the proximal transverse colon. Necrotic portions were resected and the Periodic Acid Schiff and Grocott's methenamine silver staining of the resected specimen showed septated fungal hyphae with acute angle branching, suggesting aspergillus species (Fig. 3). The patient was finally diagnosed with colonic IA. Intravenous liposomal amphotericin-B (3 mg/kg/day) was additionally administered for 35 days. He was discharged with oral voriconazole to treat his reported remaining, abdominal discomfort and mildly elevated CRP levels. Voriconazole was discontinued at a follow-up visit to the outpatient department 2 weeks after discharge when his abdominal discomfort had relieved and CRP levels normalized.

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