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Gastric and colonic aspergillosis

Ulceration and bleeding from gastric or colonic ulcers caused by aspergillosis has been occasionally recorded and is typically an end-stage manifestation of disseminated aspergillosis. It may occur in leukaemia, following transplantation and in late-stage AIDS patients (Kinder, 1985, Denning, 1991, Prescott, 1992, Foy, 1994). Gastrointestinal infarction has also been reported and can occur with either Aspergillus or the Mucorales (Cohen,1992, Catalano 1997). Polypoid masses in the stomach in non-immunocompromised patients have also been reported (Prescott, 1994).

Control of bleeding is paramount and may be difficult because of a low platelet count and/or a bleeding diathesis associated with invasive aspergillosis (McClellan,1985). Systemic antifungal therapy with amphotericin B (1 mg/kg/day) is necessary, or use of one of the lipid-associated amphotericin B preparations in large doses. A search for other foci of aspergillosis is also appropriate.

David W. Denning FRCP FRCPath FIDSA FMedSci
Professor of Medicine and Medical Mycology
Director, National Aspergillosis Centre
Education and Research Centre
University Hospital of South Manchester (Wythenshawe Hospital)
Southmoor Road
Manchester M23 9LT UK

April 1998