title: Unusual case of bowel infarction with invasive Aspergillus in an immunocompromised patient.
abstract: BACKGROUND
  We report a patient with bowel infarction due to invasive Aspergillus infection as a result of prolonged chemotherapy-induced neutropenia.
  
  
  METHODS
  The patient was given neoadjuvant chemotherapy with doxorubicin, docetaxel, and capecitabine for a breast tumour. She developed prolonged neutropenia, Escherichia coli and Candida krusei sepsis, acute arterial thrombosis of the left lower limb, and invasive aspergillus infection.
  
  
  METHODS
  She underwent a subtotal colectomy, small intestine resection and an above-knee amputation.
  
  
  RESULTS
  The hospitalisation was complicated with methicillin-resistant Staphylococcus aureus pneumonia and short gut syndrome. She subsequently underwent simple mastectomy with axillary clearance and received adjuvant chemotherapy and radiation without complication.
  
  
  CONCLUSIONS
  Chemotherapy should be protocol-directed. In a non-trial situation, protocol must have a sound basis, proven safety, and efficacy. Aspergillus infection is uncommon in patients with solid tumours; prompt treatment must be started on high suspicion.
authors.affiliation: Department of Medical Oncology, National Cancer Centre, Singapore, 11 Hospital Drive, Singapore 169610. dmotmh@nccs.com.sg
authors.forename: M H
authors.initials: MH
authors.lastname: Tay
authors.forename: C
authors.initials: C
authors.lastname: Balram
authors.forename: K F
authors.initials: KF
authors.lastname: Foo
authors.forename: I
authors.initials: I
authors.lastname: Busmanis
authors.forename: S
authors.initials: S
authors.lastname: Raman
authors.forename: K S
authors.initials: KS
authors.lastname: Khoo
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications*; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy; D018270:Carcinoma, Ductal, Breast / Q000150:complications / Q000188:drug therapy; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007238:Infarction / Q000382:microbiology*; D007421:Intestine, Small / Q000098:blood supply*; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced