title: Invasive aspergillosis in patients with cirrhosis, a case report and review of the last 10 years.
abstract: BACKGROUND
  Untreated invasive aspergillosis (IA) is lethal, yet diagnosis is often delayed. Recognising the risk factors can lead to earlier diagnosis. We present a case of an invasive pulmonary aspergillosis in a patient with cirrhosis, who had been treated with corticosteroids for 2.5 weeks for alcoholic hepatitis. He was successfully treated with liposomal amphotericin B and caspofungin (first in combination, then caspofungin monotherapy).
  
  
  OBJECTIVE
  To evaluate the role of aspergillosis in cirrhosis.
  
  
  METHODS
  A literature search on aspergillosis in cirrhosis and liver failure patients was conducted in PubMed/Medline (2002-dec 2012), according to pre-set selection criteria.
  
  
  RESULTS
  20 out of 330 articles were retrieved, representing 43 patients with cirrhosis and/or liver failure who had an aspergillosis infection. Most Aspergillus (A.) infections were due to A. fumigatus and the lungs were the most frequent organ involved (42/43). 58% of the patients used steroids and mortality was 53.5%. The most frequent used antifungal was caspofungin.
  
  
  CONCLUSIONS
  Diagnosis of IA is difficult and there might be a delay in diagnosis since cirrhosis is not recognised as one of the classical risk factors. Mortality was 53.5%, but this is lower than in previous decades. Since voriconazole is hepatotoxic, treatment with caspofungin and/or amphotericin is preferable.
  
  
  CONCLUSIONS
  Early recognition of aspergillosis in a cirrhosis/liver failure patient is crucial and should prompt direct treatment.
authors.affiliation: Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium. sarah.jeurissen@ugent.be
authors.forename: S
authors.initials: S
authors.lastname: Jeurissen
authors.affiliation: Department of General Internal Medicine and Infectious Diseases, Ghent University, Ghent, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Vogelaers
authors.affiliation: Department of General Internal Medicine and Infectious Diseases, Ghent University, Ghent, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Sermijn
authors.affiliation: Department of Internal Medicine, Hospital "AZ Gezondheidszorg", Oostkust, campus "OLV Ter Linden", Knokke, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Van Dycke
authors.affiliation: Department of Hepatology and Gastroenterology, Ghent University Hospital, Ghent, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Geerts
authors.affiliation: Department of Hepatology and Gastroenterology, Ghent University Hospital, Ghent, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Van Vlierberghe
authors.affiliation: Department of Hepatology and Gastroenterology, Ghent University Hospital, Ghent, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Colle
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D000077336:Caspofungin; D054714:Echinocandins / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy*; D055666:Lipopeptides; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077336:Caspofungin