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Journal of Medical Case Reports

, 8:407

First Online: 05 December 2014Received: 08 June 2014Accepted: 26 October 2014DOI: 10.1186-1752-1947-8-407

Cite this article as: Bizet, J., Cooper, C.J., Zuckerman, M.J. et al. J Med Case Reports 2014 8: 407. doi:10.1186-1752-1947-8-407

Abstract

IntroductionInvasive Aspergillus commonly involves the lungs, but can also affect other organs such as the skin, adrenal glands, central nervous system, liver, spleen and the gastrointestinal tract. Gastrointestinal aspergillosis is rare and is most often discovered in immunocompromised patients. There is only one other case report to our knowledge that describes the diagnosis being discovered on histopathological analysis of endoscopic biopsies of necrotic ulcers.

Case presentationA 36-year-old Hispanic woman presented with septic shock secondary to extensive Fournier gangrene that required multiple surgical debridement of the perineal and retroperitoneal area. Her vital signs on admission were a temperature of 39.4°C and blood pressure of 85-56mmHg, pulse rate of 108-min and respiratory rate of 25. An examination of the perineum-genital area revealed bilateral gluteal and perilabial edema, erythema and focal areas of necrotic tissue with purulent discharge. Other surgeries included small bowel resections with ileoileal anastomosis that later developed an anastomotic leak that required and diverting end ileostomy. Eleven weeks after admission, our patient developed hematochezia from the colostomy associated with a decrease in hemoglobin and hematocrit to 6.4g-dL and 20.2% respectively. Colonoscopy through the ostomy revealed blood throughout the colon and a 3cm necrotic ulcer with an adherent clot in the transverse colon. Biopsies were taken from the edge of the ulcer. Histopathological analysis of the specimen with Grocott’s methenamine silver stain revealed septated hyphae with the 45-degree-angle branching that is morphologically consistent with Aspergillus species. Our patient was treated with intravenous voriconazole for 30 days with a prolonged hospitalization but no recurrent bleeding.

ConclusionsGastrointestinal aspergillosis is an unusual presentation of invasive Aspergillus associated with a high mortality rate. Characteristic features of gastrointestinal aspergillosis include invasion of the mesenteric arteries, intravascular thrombosis and subsequent tissue ischemia. Clinical manifestations of invasive Aspergillus of the gastrointestinal tract can include fever, abdominal pain, ileus, peritonitis, bloody diarrhea or hematochezia. In an autopsy series of patients with invasive Aspergillus, 37 of 107 patients had Aspergillus involvement of the gastrointestinal system; the most common pathological findings included ulcers and abscesses. Although rare, invasive aspergillosis may present with gastrointestinal bleeding associated with necrotic ulcers on endoscopic examination.

KeywordsInvasive Aspergillus Aspergillosis Gastrointestinal bleeding Immunosuppression AbbreviationsCTcomputed tomography

ELISAenzyme-linked immunosorbent assay

GMSGrocott’s methenamine silver

HandEhematoxylin and eosin

IAinvasive Aspergillus.

Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-8-407 contains supplementary material, which is available to authorized users.

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Author: Jorge Bizet - Chad J Cooper - Marc J Zuckerman - Alireza Torabi - Antonio Mendoza-Ladd

Source: https://link.springer.com/







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