Published in:
01-08-2016 | Case Report
Resolution of Isolated, Aspergillus Colonization in a Deep Esophageal Ulcer in an Immunocompetent Patient with Ulcer Healing Without Specific Antifungal Therapy
Published in: Digestive Diseases and Sciences | Issue 8/2016
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Isolated gastrointestinal (GI) aspergillosis is relatively rare with only 18 previously reported cases, and in all these cases, the Aspergillus infection was invasive and occurred in immunosuppressed patients (Table 1; [1‐11]). A case is reported of isolated, superficial, Aspergillus GI infection with novel features including: (1) Aspergillus colonizing a deep esophageal ulcer without tissue invasion, (2) this colonization occurring in an immunocompetent patient, and (3) resolution of the colonization with antiulcer therapy without antifungal therapy.
Table 1
Clinical presentation, diagnosis, treatment, and outcome in the 18 previously reported cases of isolated gastrointestinal aspergillosis
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Reference: first author, year
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Age in years, sex
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Clinical presentation
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Underlying immunosuppression
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Leukocyte count, ANC (109/L)
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Lesion location type
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Diagnosis
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Medical or surgical treatment
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Patient outcome
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|---|---|---|---|---|---|---|---|---|
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Esophageal lesions
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||||||||
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1. Current report
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52, M
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Dysphagia, weight loss
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None
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Esophagus-deep ulcer
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EGD and biopsy: superficial, truly septated hyphae with acute-angle branching consistent with Aspergillus (colonization)
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Oral omeprazole
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Survived, no recurrence during 8 months of follow-up
|
|
|
2. Erikci 2009 [1]
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18, M
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Dysphagia, retrosternal pain
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ALL
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0.4, 0
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Esophagus-erosions
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EGD: esophageal erosions, Biopsy: Aspergillus
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IV amphotericin B and caspofungin
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Symptoms resolved
|
|
3. Alioglu 2007 [2]
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15, M
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Dysphagia and vomiting
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AML
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NR, NR
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Esophagus-ulcers and stenosis
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EGD and biopsy: fungal hyphae with acute-angle branching
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IV amphotericin B and caspofungin, G-CSF
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Survived
|
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4. Bergman 2004 [3]
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79, F
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NR
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AML
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NR, NR
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Esophagitis
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EGD and esophageal brushing cytology: fungal organisms consistent with Aspergillus
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NR
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Expired 1 week later
|
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5. Chionh 2005 [4]
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71, M
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Epigastric pain and hematemesis
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AML
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92.5, 0.25
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Esophagus-exophytic lesion
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EGD and biopsy: fungal hyphae and yeast forms consistent with Aspergillus
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Oral voriconazole, G-CSF
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Survived
|
|
6. Choi 1997 [5]
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35, M
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Nausea, vomiting, and odynophagia
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AML status post allogenic bone marrow transplant
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5.5, NR
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Esophagus-ulcer
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EGD: shallow esophageal ulcer, biopsy: dichotomously branching septate hyphae consistent with Aspergillus
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IV amphotericin B
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Symptoms resolved
|
|
7. Yoo [6]
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50, M
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Odynophagia
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AML
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15.8, 3
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Esophagus-mass
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EGD and biopsy: dichotomously branching septate hyphae strongly suggesting Aspergillus
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IV amphotericin B
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Survived, resolution of mass after 1 month
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|
Gastric lesions
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||||||||
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8. Kazan 2011 [7]
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51, M
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NR
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Multiple myeloma
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NR, >0.5
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Stomach
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EGD: fungal culture positive for Aspergillus
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Surgery
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Died at day 17
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|
Small intestinal lesions
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||||||||
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9. Kazan 2011 [7]
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56, F
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NR
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AML
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NR, <0.5
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Duodenum
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EGD: fungal culture positive for Aspergillus
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Surgery
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Survived
|
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10. Kazan 2011 [7]
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70, F
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NR
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AML
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NR, <0.5
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Duodenum
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Fungal culture negative
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Laparotomy
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Survived
|
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11. Eggimann 2006 [8]
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52, M
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Abdominal pain, septic shock
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AML (transformed from myelodysplasia)
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NR, <0.5
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Ileum masses
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Biopsy and culture positive for Aspergillus
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Laparotomy, IV amphotericin B
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Expired 2 months later
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12. Trésallet 2004 [9]a
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57, NR
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Persistent fever, peritonitis
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Lymphoma
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NR, <0.5
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Ileum necrosis
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Histology and culture positive for Aspergillus
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Bowel excision, voriconazole
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Survived
|
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13. Gonzalez 2008 [10]
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19, M
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Abdominal pain and GI bleeding
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Wilm’s tumor, Autologous PBSCT
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NR, NR
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Small bowel ulcer
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Biopsy: septate hyphae with acute-angle branching, Fungal culture: positive for Aspergillus fumigatus
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Laparotomy with ileal resection, G-CSF
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Expired few hours later
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14. Kazan 2011 [7]
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54, F
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NR
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AML
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NR, <0.5
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Small bowel
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NR
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Laparotomy
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Died on day of surgery
|
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15. Marterre 1992 [11]
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9, M
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Fever, ileus, peritonitis, small bowel obstruction
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ALL
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NR, >0.5
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Small bowel
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Histology and culture positive for Aspergillus
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Bowel excision
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Survived
|
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Colonic and appendiceal lesions
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||||||||
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16. Kazan 2011 [7]
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19, M
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NR
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AML
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NR, <0.5
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Appendix
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NR
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Laparotomy
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Survived
|
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17. Kazan 2011 [7]
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62, F
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NR
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AML
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NR, >0.5
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Colon
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Colonoscopy: fungal culture positive for Aspergillus
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NR
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Survived
|
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18. Kazan 2011 [7]
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24, F
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NR
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CML
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NR, <0.5
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Colon
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NR
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Laparotomy
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Died at day 57
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19. Kazan 2011 [7]
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58, F
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NR
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ALL
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NR, >0.5
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Colon
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Colonoscopy, culture positive for Aspergillus
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NR
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Survived
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