Korean J Crit Care Med.  2016 May;31(2):129-133. 10.4266/kjccm.2016.31.2.129.

Primary Invasive Intestinal Aspergillosis in a Non-Severely Immunocompromised Patient

• Gil E
• Ha TS
• Suh GY
• Chung CR
• Park CM

• KMID: 2350920
• DOI: http://doi.org/10.4266/kjccm.2016.31.2.129

Abstract

Invasive aspergillosis (IA) is most commonly seen in patients with risk factors, such as cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation and acquired immune deficiency syndrome. IA commonly occurs in the respiratory tract. Extrapulmonary aspergillosis is usually a part of a disseminated infection, and primary invasive intestinal aspergillosis is very rare. Herein, we report a case of an immunocompetent 53-year-old male who suffered recurrent septic shock in the intensive care unit (ICU) and was finally diagnosed as invasive intestinal aspergillosis without dissemination. IA is rarely considered for patients who do not have an immune disorder. Thus, when such cases do occur, the diagnosis is delayed and the clinical outcome is often poor. However, there is a growing literature reporting IA cases in patients without an immune disorder, mostly among ICU patients. Primary intestinal aspergillosis should be considered for critically ill patients, especially with severe disrupted gastrointestinal mucosal barrier.

Keyword

critical illness; gastrointestinal disease; aspergillosis

MeSH Terms

Acquired Immunodeficiency Syndrome
Adrenal Cortex Hormones
Aspergillosis*
Critical Illness
Diagnosis
Drug Therapy
Gastrointestinal Diseases
Humans
Immune System Diseases
Immunocompromised Host*
Intensive Care Units
Male
Middle Aged
Neutropenia
Respiratory System
Risk Factors
Shock, Septic
Adrenal Cortex Hormones

Figure

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  Fig. 1. Abdominopelvic computed tomography shows acute pancreatitis with peripancreatic infiltration and severe enterocolitis. (A) Transverse computed tomography (CT) image (B) Coronal CT image. Hospital day 1.

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  Fig. 2. A diffuse geographically-shaped mucosal ulcer was observed beginning at the anal verge (AV) 15 to 20 cm and AV 25 cm to upward on sigmoidoscopy, which is suggestive of ischemic colitis. Biopsy was done at the AV 15cm. Hospital day 10.

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  Fig. 3. Hematoxylin and eosin (A) and Grocott’s methenamine silver (B) stains (original magnification, x200) of the resected terminal ileum: The specimen shows numerous fungal hyphae with acute angle branching and angioinvasion, which is morphologically compatible with a diagnosis of invasive aspergillosis. Pathologic result was reported at postoperative day 7 (hospital day 22).

Reference

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