Aspergillosis is a potentially fatal infection usually presenting as respiratory tract infection including the sinuses, trachea and/or lungs. The organism is a common environmental contaminant, sometimes leading to a high concentration of airborne spores. A few reports have shown contamination of water or food with Aspergillus associated with the intestinal tract as portal of entry and primary focus of human disease. Such an unusual case of invasive small bowel aspergillosis with secondary dissemination is described. A 49-year-old male patient developed abdominal pain a few weeks following allogeneic blood stem cell transplantation for CML Clinical examination and imaging studies indicated small bowel subileus. Endoscopy results of the upper intestinal tract and large bowel were non-diagnostic. Rotavirus antigen was detected in the feces. A presumptive diagnosis of subilieus due to distal jejunal stenosis possibly subsequent to radiation and rotavirus superinfection was made, and symptomatic treatment was started with little improvement. A few weeks later the patient developed high-grade fever, bone marrow hypoplasia and severe pain in the left hip with radiologic signs of coxitis. Differential diagnosis included a reactivation of an earlier destructive hip tuberculosis. Blood cultures and radiographic studies of the chest including a CT scan were non-diagnostic. Necrotizing stomatitis developed with greyish pseudomembranes that repeatedly revealed pure cultures of Aspergillus fumigatus. The patient then underwent laparotomy with resection of a 30-cm stenotic part of the jejunum. The histopathologic diagnosis was invasive small bowel aspergillosis. Rapid dissemination of the aspergillosis with involvement of the lungs and brain despite therapy led to the death of the patient.
Full conference title:
9th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 9th (1999)