Small-bowel infarction from disseminated aspergillosis.
BACKGROUND
Despite the use of new, effective drugs, the disseminated invasive aspergillosis often remains lethal in neutropenic patients. Diagnosis is difficult because early symptoms are nonspecific. New tools could help in diagnosis and lead to early surgery when needed.


METHODS
A neutropenic patient developed an acute abdomen. CT findings were a diffuse, small-bowel distention with a thickened, distal, ileum wall. Emergency surgery was performed with resection and immediate anastomosis of the distal ileum. Pathology of the small bowel showed a wall necrosis and invasion by Aspergillus fumigatus.


RESULTS
The postoperative course was uneventful except for persisting diarrhea secondary to a coexistent infection with Clostridium difficile. Aspergillus antigene in serum was positive, whereas neither pulmonary nor central nervous system aspergillosis was observed on CT scan.


CONCLUSIONS
This diagnosis should be considered when neutropenic patients show abdominal pain and distention with fever. Repetition of Aspergillus antigenemia, search for others aspergillosis localizations, CT scan, and colonoscopy with biopsies should be performed until diagnosis allows the administration of early antifungal therapy.
Trésallet
Christophe
C
Department of General Surgery, Pitié Hospital, Paris, France.
Nguyen-Thanh
Quang
Q
Aubriot-Lorton
Marie-Hélène
MH
Akakpo
Jean-Paul
JP
Al Jijakli
Ahmad
A
Cardot
Vincent
V
Chigot
Jean-Paul
JP
Menegaux
Fabrice
F
D015746:Abdominal Pain / Q000209:etiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications*; D001232:Aspergillus fumigatus / Q000302:isolation & purification* / Q000472:pathogenicity*; D005134:Eye Neoplasms / Q000188:drug therapy; D005260:Female; D006801:Humans; D007238:Infarction / Q000209:etiology* / Q000382:microbiology*; D007421:Intestine, Small / Q000382:microbiology* / Q000473:pathology*; D008223:Lymphoma / Q000188:drug therapy; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications