Purpose: Female patient, 9 years old, previously healthy, began with jaundice associated with sudden dark urine and fecal acholia. Methods: We researched the etiology of hepatitis without identification. The patient developed fever, worsening jaundice, hepatic encephalopathy and bleeding disorders. She was admitted to the intensive care unit and liver transplant indicated by fulminant hepatitis installed. Was performed liver transplantation, akin livin donor, 20 days after onset. The procedure was performed uneventfully. The patient received prophylaxis with ampicillin, cefotaxime and fluconazole. Postoperatively the patient developed fever, pancytopenia with positive antigenemia for cytomegalovirus. Received antithymocyte globulin (ATG) and ganciclovir with recovery of pancytopenia, but later started complaining of dyspnea and hemodynamic instability and recurrence of fever during investigation of the infectious focus was made tomography which showed bilateral micronodules and nodules> 1.5 cm at the base of right lung associated with pleural effusion. Results: Performed galactomannan (Bio-Rad Platelia ® Aspergillus), two measures, which resulted in positive 2.2 and 9.9. The result was released with the observation that the child, the presence of Bifidobacterium spp in the intestinal mucosa, false positive could occur. We performed RT-PCR for Aspergillus fumigatus that was positive with subsequent confirmation, of the amplified product of conserved sequence of Aspergillus fumigatus of approximately 400 bp, in agarose gel 2%. Lung biopsy revealed the presence of hyphae compatible with Aspergillus sp and sputum culture grew Aspergillus fumigatus. Despite antifungal therapy used the patient presented important hemodynamic and respiratory instability evolving cardio respiratory arrest and death. Autopsy was performed by dissecting the viscera monoblock, about 12 hours after death. Is noticed multiple suffusion of the skin, parietal pleura, pericardium, peritoneum and pelvic organs. The lungs appeared heavy, thickened pleura, opaque, with multiple whitish nodules, with depressed center, clearly defined, some confluent, scattered throughout the outer surface. On sectioning, the parenchyma presented with hemorrhagic, with multiple nodules and the pleural. Conclusions: The microscopy, we identified severe hypoplasia at the expense of the three sets germ lymphocyte depletion in lymph nodes and spleen, indicating a severe immunosuppression. In the lung, we found invasive aspergillosis with vasculitis in various stages of development, associated with its complications such as vascular thrombosis, alveolar hemorrhage, infarction, and severe fungal embolization. Vasculitis associated with Aspergillus sp and hemorrhages were found in the stomach, heart, pleura, pericardium and peritoneum.
Full conference title:
4th Advances Against Aspergillosis
- AAA 4th (2010)