title: Acute isolated appendicitis due to Aspergillus carneus in a neutropenic child with acute myeloid leukemia.
abstract: We describe a case of isolated acute appendicitis due to Aspergillus carneus in a neutropenic child with acute myeloid leukemia (AML) treated according to the AIEOP AML 2002/01 protocol. Despite prophylaxis with acyclovir, ciprofloxacin and fluconazole administered during the neutropenic phase, 16 days after the end of chemotherapy the child developed fever without identified infective foci, which prompted a therapy shift to meropenem and liposomial amphotericin B. After five days of persisting fever he developed ingravescent abdominal lower right quadrant pain. Abdominal ultrasound was consistent with acute appendicitis and he underwent appendectomy with prompt defervescence. PAS+ fungal elements were found at histopathology examination of the resected vermiform appendix, and galactomannan was low positive. A. carneus, a rare species of Aspergillus formerly placed in section Flavipedes and recently considered a member of section Terrei, was identified in the specimen. Treatment with voriconazole was promptly started with success. No other site of Aspergillus localization was detected. Appendicitis is rarely caused by fungal organisms and isolated intestinal aspergillosis without pulmonary infection is unusual. To our knowledge, this is the first report of infection due to A. carneus in a child and in a primary gastrointestinal infection.
authors.affiliation: Pediatric Hematology/Oncology, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
authors.forename: Nunzia
authors.initials: N
authors.lastname: Decembrino
authors.affiliation: Pediatric Hematology/Oncology, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zecca
authors.affiliation: Department of Biomedical Science for Health, University of Milan, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Tortorano
authors.affiliation: Microbiology and Virology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mangione
authors.affiliation: Microbiology and Virology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Lallitto
authors.affiliation: Pediatric Hematology/Oncology, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Introzzi
authors.affiliation: Pediatric Hematology/Oncology, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Bergami
authors.affiliation: Microbiology and Virology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Marone
authors.affiliation: Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Tamarozzi
authors.affiliation: Microbiology and Virology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Cavanna
mesh_terms: D000208:Acute Disease; D000212:Acyclovir / Q000627:therapeutic use; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D001064:Appendicitis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D001228:Aspergillosis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D001230:Aspergillus / Q000187:drug effects / Q000302:isolation & purification*; D002648:Child; D002939:Ciprofloxacin / Q000627:therapeutic use; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D009503:Neutropenia / Q000150:complications*; D011743:Pyrimidines / Q000627:therapeutic use; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D002939:Ciprofloxacin; D000666:Amphotericin B; D015725:Fluconazole; D065819:Voriconazole; D000212:Acyclovir
keywords: Appendicitis; Aspergillus carneus; Galactomannan; Leukemia; Voriconazole