Unusual case of bowel infarction with invasive Aspergillus in an immunocompromised patient.
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.
Tay
M H
MH
Department of Medical Oncology, National Cancer Centre, Singapore, 11 Hospital Drive, Singapore 169610. dmotmh@nccs.com.sg
Balram
C
C
Foo
K F
KF
Busmanis
I
I
Raman
S
S
Khoo
K S
KS
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