A 36-year-old Hispanic man who had undergone allogeneic bone marrow transplantation, complicated by graft versus host disease, was admitted with acute gastrointestinal symptoms, including severe diarrhea and diffuse abdominal pain. He also had a persistent cough with sputum production. Blood cultures yielded Escherichia coli, and sputum cultures grew Apergillus species. The patient was treated with antifungal agents and broad-spectrum antibiotics. Despite aggressive medical therapy, the patient died 10 days after admission. Postmortem examination disclosed severe, bilateral confluent bronchopneumonia, with numerous septated branching hyphae consistent with Aspergillus species fungal organisms that involved the pulmonary parenchyma and tracheobronchial tree. Although the small and large bowels were only mildly congested, the entire gastric mucosa was covered with a 1.5-cm-thick pseudomembrane that contained numerous Aspergillus organisms. Our report represents the first description, to our knowledge, of a diffuse inflammatory pseudomembrane in the stomach, a complication that to date has only been associated with small and large bowel involvement.
"When involvement of the sinuses occurs, IA often clinically resembles Zygomycosis (mucormycosis) of the sinuses. Profoundly immunocompromized patients can occasionally develop gastrointestinal IA from swallowed organisms that subsequently invade the gut mucosa, which can present with gastrointestinal bleeding or nonspecific signs of an acute abdomen and fever and might be confused with GVHD in allo-HCT recipients or neutropenic eneterocolitis in severely neutropenic patients  . A very serious complications occur when fungal invasion directly spreads to central nervous system involving various anatomic structures of the brain  or to ethmoid sinus with a farther advance to cavernous sinus . "
[Show abstract][Hide abstract] ABSTRACT: Invasive aspergillosis is most commonly seen in patients with immune disorders and usually in the lung. Local invasive aspergillosis of the gastrointestinal system is quite rare. A 13-year-old female without immune deficiency presented with acute abdomen due to full-thickness necrosis of the gastric fundus. The necrotic gastric wall was excised and the stomach repaired. The pathology revealed a gastric ulcer with invading Aspergillus hyphae and spores. Aspergillosis is an opportunistic infection and its spores cannot survive in the normal gastric mucosa. The Aspergillus spores in this case probably grew on a background of gastric ulcer and caused wall necrosis and that the surgical treatment possibly provided a cure because it remained localized to the gastric wall.
Surgery Today 08/2012; 43(6). DOI:10.1007/s00595-012-0255-0 · 1.53 Impact Factor
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