Disseminated aspergillosis

Aspergillosis myocarditis in the immunocompromised host

Invasive cardiac aspergillosis has been rarely described in immunocompromised patients. This disease is difficult to diagnose by conventional laboratory, microbiologic, and imaging techniques, and is often recognized only post-mortem. The authors present the case of a 60-year-old woman admitted with an exacerbation of eosinophilic granulomatosis with polyangitiis (EGPA) who subsequently died from Aspergillus myocarditis, and compare the patient’s case to prior literature. This serves as an up-to-date literature review on the topic of invasive cardiac aspergillosis.

Mycotic aneurysm of the thoracic aorta due to Aspergillus terreus: case report and review

Mycotic aneurysms of the aorta caused by fungi are uncommon. We describe an unusual case of aortic aneurysm infection caused by Aspergillus terreus, which most likely spread from an adjacent pulmonary focus. Successful treatment included partial pneumonectomy, resection of the aneurysm with graft repair, and prolonged sequential administration of amphotericin B and itraconazole. A review of the published experience with aortic aneurysms caused by Aspergillus species is also presented. When invasive aspergillosis is suspected in proximity to areas with major vascular structures in immunocompromised patients, further investigation to rule out vascular invasion may be warranted. If the diagnosis is confirmed, aggressive and prompt treatment with antifungal agents combined with surgical debridement is essential to improve outcome.

Invasive pulmonary aspergillosis diagnosed by blood culture and successfully treated

We present a case of invasive pulmonary aspergillosis when a blood culture isolate of Aspergillus fumigatus in an unusual medium was considered to be a genuine isolation. Early institution of appropriate therapy was successful.

Aspergillosis of the central nervous system: clinicopathological analysis of 17 patients

The clinical, laboratory, and pathological features of aspergillosis of the central nervous system (CNS) were studied in a series of 17 autopsied patients. Two groups were defined. Group A consisted of 8 patients with diseases commonly associated with CNS aspergillosis: leukemia, lymphoma, aplastic anemia, and renal transplantation. Group B contained 9 patients with various illnesses not generally known to be associated with CNS aspergillosis. CNS aspergillosis was diagnosed and treated before death in only 1 patient. Patients in Group A received cytotoxic drugs, often had granulocytopenia, less commonly had focal neurological deficits, and seldom had seizures. Group B patients were not granulocytopenic, received no cytotoxic agents, underwent nontransplant surgery, and more frequently had focal neurological deficits. Eleven of the 17 patients (65%) had focal deficits, most of them hemiparesis. Meningeal signs were rare, but the cerebrospinal fluid was usually abnormal. The principal neuropathological process was Aspergillus invasion of blood vessels causing hemorrhagic infarction. Focal clinical deficits correlated neuroanatomically with Aspergillus lesions. In 2 patients, such lesions were detected by 99mTc-DTPA or cerebral angiography before computed tomographic scanning. The lungs were the usual portal of entry, but isolated CNS lesions occurred in 2 patients. CNS aspergillosis should be considered as a cause of new onset of focal neurological deficits in patients with illnesses that are more diverse than has generally been appreciated.

Invasive aspergillosis of the hand

Aspergillosis is a fungal infection which may disseminate from the lung to bone, meninges, heart, or other organs. It is commonly found in patients with debilitating disease and those undergoing chemotherapy. A 6-year-old boy, seen at Fitzsimons Army Medical Center while being treated for acute monomyelocytic leukemia, developed invasive aspergillosis of the hand, requiring resection of the central three rays. This rare presentation of the disease required radical surgery to control its local manifestations and to prevent widespread dissemination.

Granulomatous mediastinitis due to Aspergillus flavus in a nonimmunosuppressed patient

A patient with granulomatous mediastinitis due to Aspergillus flavus is described. A 22 year old black man presented with cough, fever and a right hilar mass. Mediastinal biopsies revealed granulomatous fibrosing mediastinitis with fungal elements compatible with aspergillus species. A flavus was isolated on culture of this material and later from sputum and bronchial washings. Studies of the patient's immune status revealed normal humoral and cellular immunity. No underlying neoplasm was found. The patient was treated with amphotericin B and 5-fluorocytosine but esophageal and superior vena caval compression developed and he died. This is the first reported case of granulomatous mediastinitis due to A. flavus in a patient whose immune responses were not suppressed (nonimmunosuppressed patient). Infection with Aspergillus species should be considered in the differential diagnosis of granulomatous mediastinitis.

Cerebral aspergilloma in a patient with allergic bronchopulmonary aspergillosis

The case is described of a woman of 21 who had suffered since childhood from asthma and allergic bronchopulmonary aspergillosis. During her recovery from a period of severe status asthmaticus she developed widespread patchy lung shadowing, signs of an intracerebral space-occupying lesion and high titres of serum precipitins to Aspergillus fumigatus. Post-mortem examination revealed Aspergillus bronchopneumonia and an intracerebral aspergilloma.