Yonsei Med J.  2015 Sep;56(5):1453-1456. 10.3349/ymj.2015.56.5.1453.

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

• KMID: 2163644
• DOI: http://doi.org/10.3349/ymj.2015.56.5.1453

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.

Keyword

Invasive aspergillosis; colon perforation; immunocompetent host

MeSH Terms

Amphotericin B/administration & dosage/therapeutic use
Antifungal Agents/administration & dosage/*therapeutic use
Aspergillosis/*diagnosis/drug therapy/microbiology/surgery
Aspergillus/*isolation & purification
Colon/microbiology/radiography/*surgery
Colonic Diseases/diagnosis/therapy
Combined Modality Therapy
Humans
*Immunocompetence
Laparotomy
Male
Middle Aged
Treatment Outcome
Voriconazole/administration & dosage/therapeutic use
Amphotericin B
Antifungal Agents
Voriconazole

Figure

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  Fig. 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.

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  Fig. 2 (A) Erect abdominal X-ray showing gaseous distention of small bowel loops with an absence of colonic gas, suggestive of mechanical obstruction. (B and C) Enhanced abdominal computed tomography scan showing multifocal wall disruption (arrows) of the hepatic flexure of the ascending colon and proximal transverse colon with large amount of ascites and peritoneal thickening, suggestive of pan-peritonitis.

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  Fig. 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.

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