Generalized Aspergillosis Presenting as Thyroid Abscesses in a Patient with Wegener's Granulomatosis

R. Gattringer, N. Kozakowski, B. Willinger, W. Graninger, E. Prester*.

Author address: 

Dept. of Medicine, Div. Infectious Diseases, end Dept. of Clinical Microbiology, Medical University of Vienna, Austria

Abstract: 

Background: Invasive asper~illosis is a severe complication occurring most commonly in neutropenic patients with leukemia or bone marrow transplantation. We describe the course and the antifunga[ treatment of in a non-neutropenic patient with generalized aspergillosis. Case report: A 63-year old woman with renal Wegener's granulomatosis developed fever refractory to imipenem, vancomycin and fluconazo[e after 3-months treatment with cydophospamid (1 g every 4 weeks) and predniso[on 0.5-1 mg/kg. ACT scan showed abscesses in the thyroid gland besides unspecific infiltrates within both lungs. The aspiration of a thyroid abscess yielded the growth of Aspergillus flavus. The patient did not respond to the treatment of voriconazo[e and was transferred to our hospital The patient was in a reduced genera[ condition with a normal neutrophi[ count, a slightly elevated serum creatinine and no signs of active Wegener's granu[omatosis. A MRT of the skull revealed a lesion in the brain compatible with cerebra[ aspergillosis. The CT scan of the tung was suggestive for pulmonary aspergillosis. A combination therapy with amphotericin B (1 mg/kg/24 h) plus caspofungin 50mg/d was started. At[ immunosuppressive treatment was stopped. The patient's condition improved. However she complained of increasing nausea and absolute toss of appetite. Thus parentera[ nutrition was started. Eight weeks after initiation of therapy, the cerebra[ lesion was slightly smatter, the pu[mona[ lesions were increasing. Additionally, subcutaneaous nodules and abcesses in the myocardium were detected. Artificial respiration had to be started because of respiratory failure. A further aspiration of the stilt existing thyroid abscesses revealed masses of hyphal elements but no growth in the fungal culture. Panfungal PCR hinted the presence of an ascomycete other than Aspergillus. The antifungal therapy was switched to amphotericin B plus voriconazole, then to oral posaconazole. The patient improved. Because of increasing cholestasis, posaconazole was stopped after 3 weeks. The patient died 14 days tater. The autopsy revealed suppurative cho[angitis, the cultures are still pending. Discussion: Generalized aspergillosis is considered a disease in neutropenic patients. However, in severely immunosuppressed patients multifocal fungal disease caused by more than one fungal species may develop.
2006

abstract No: 

S79

Full conference title: 

14th International Symposium of Infections in the Immunocompromised Host
    • ISIIH, 14th