title: A case of Aspergillus fumigatus peritonitis complicating liver transplantation.
abstract: A 55-year-old male underwent orthotopic liver transplantation for sub-fulminant hepatitis B/delta infection superimposed on probable genetic hemochromatosis with early cirrhosis. Pre-operatively, he demonstrated serologic evidence of cytomegalovirus reactivation and developed cytomegalovirus viremia when ganciclovir was discontinued post-operatively. His post-operative course was complicated by chronic ductopenic rejection, biliary anastomotic leak, and persistent confusion and malaise. At the time of laparotomy for repair of the bile leak, nodular peritoneal lesions were noted, with biopsy and culture showing angioinvasive Aspergillus fumigatus. Despite administration of amphotericin B, the patient continued to have culture-confirmed evidence of infection at follow-up peritoneoscopy. Oral itraconazole was begun, but the patient died of liver failure secondary to progressive ductolpenic rejection. At autopsy, Aspergillus organisms were seen in histologic sections taken from the small bowel; there was no evidence of disseminated disease.
authors.affiliation: Division of Infectious Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: J S
authors.initials: JS
authors.lastname: Sartin
authors.forename: M P
authors.initials: MP
authors.lastname: Wilhelm
authors.forename: M R
authors.initials: MR
authors.lastname: Keating
authors.forename: K
authors.initials: K
authors.lastname: Batts
authors.forename: R A
authors.initials: RA
authors.lastname: Krom
mesh_terms: D001232:Aspergillus fumigatus; D006509:Hepatitis B / Q000601:surgery; D003699:Hepatitis D / Q000601:surgery; D006801:Humans; D016867:Immunocompromised Host; D007421:Intestine, Small / Q000382:microbiology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000382:microbiology*; D011183:Postoperative Complications / Q000382:microbiology*