title: Disseminated aspergillosis in an immunocompetent patient with detectable bis(methylthio)gliotoxin and negative galactomannan.
abstract: BACKGROUND
  Disseminated invasive aspergillosis is an exceptional finding in immunocompetent hosts. As in immunocompromised patients, it has high mortality rates. Early diagnostic methods are required in order to properly manage the patient. Bis(methylthio)gliotoxin (bmGT) is a novel biomarker, useful in onco-hematological patients.
  
  
  METHODS
  A 70-year-old male, with non-insulin dependent type II diabetes mellitus and a past surgery history of aortic valve replacement with coronary by-pass five years ago, was seen in the emergency department with blurred vision. Three days later, endogen endophthalmitis was diagnosed in the ophthalmology clinic. During admission for the vitrectomy, he suffered an ischemia of the right lower limb. A thoracic computed tomography revealed a mycotic aneurysm of the ascending thoracic aorta and parietal thrombus. The ascending aorta was replaced and abundant brittle material of infectious appearance, found between the aortic valve graft and the aneurysm, was removed. Aspergillus fumigatus sensu stricto grew in both vitreous and aorta cultures. BmGT was detected in two serum samples obtained prior to intravenous antifungal treatment, which was then reduced after voriconazole treatment was started.
  
  
  CONCLUSIONS
  Disseminated invasive aspergillosis is a severe disease regardless of the immune status of the patient. This case report suggests that bmGT could be a suitable early diagnostic biomarker, not only in neutropenic patients, but also in immunocompetent hosts.
authors.affiliation: Universidad de Zaragoza, Microbiology, Preventive Medicine and Public Health, Zaragoza, Spain. Electronic address: mvidalg@unizar.es.
authors.forename: Matxalen
authors.initials: M
authors.lastname: Vidal-García
authors.affiliation: Unidad de Cuidados Intensivos - Hospìtal Universitario Miguel Servet, Universidad de Zaragoza, Zaragoza, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Sánchez-Chueca
authors.affiliation: Instituto de Carboquímica ICB-CSIC, Zaragoza, Spain.
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Domingo
authors.affiliation: Servicio de Cardiología - Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ballester
authors.affiliation: Servicio de Microbiología - Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Roc
authors.affiliation: Servicio de Microbiología - Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Ferrer
authors.affiliation: Servicio de Microbiología - Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Revillo
authors.affiliation: Fundación Instituto de Investigación Sanitaria Aragón, Centro de Investigación Biomédica de Aragón, Fundación ARAID, Universidad de Zaragoza, Spain.
authors.forename: Julián
authors.initials: J
authors.lastname: Pardo
authors.affiliation: Instituto de Carboquímica ICB-CSIC, Zaragoza, Spain.
authors.forename: Eva María
authors.initials: EM
authors.lastname: Gálvez
authors.affiliation: Universidad de Zaragoza, Microbiology, Preventive Medicine and Public Health, Zaragoza, Spain; Servicio de Microbiología - Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rezusta
mesh_terms: D000368:Aged; D001228:Aspergillosis / Q000097:blood*; D015415:Biomarkers; D005690:Galactose / Q000031:analogs & derivatives; D005912:Gliotoxin / Q000031:analogs & derivatives* / Q000097:blood; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008351:Mannans / Q000097:blood
chemical_list: D015415:Biomarkers; D008351:Mannans; C451025:methylthiogliotoxin; C012990:galactomannan; D005912:Gliotoxin; D005690:Galactose
keywords: Aneurisma micótico; Aspergilosis diseminada; Bis(methylthio)gliotoxin; Bis(metiltio)gliotoxina; Diagnosis; Diagnóstico; Disseminated aspergillosis; Galactomanano; Galactomannan; Gliotoxin; Gliotoxina; Mycotic aneurysm