Chaudhary Amit, Jain Vinod, Dwivedi Rama S, Misra Samir
Department of Surgery, King George Medical University, Lucknow, India.
J Carcinog. 2006 Jun 6;5:18. doi: 10.1186/1477-3163-5-18.
To report a 45 year old lady presenting with proximal jejunal gangrene due to invasive Aspergillosis. The patient was undergoing adjuvant chemotherapy for advance carcinoma of breast (Stage IV).
The patient was referred to our surgical emergency for acute abdominal symptoms for 6 hours. Histopathology revealed bowel wall necrosis and vascular invasion by Aspergillus Fumigatus. Postoperative recovery was uneventful and the patient received Amphotericin-B (1 mg/kg/day) for invasive aspergillosis. Invasive pulmonary aspergillosis was confirmed by isolating Aspergillus Fumigatus from bronchoalveolar lavage and by a positive circulating galactomannan test (ELISA Assay).
Detailed history revealed dry cough and two episodes of haemoptesis for 2 weeks. Haemogram and counts revealed anemia and neutropenia. Plain X-ray of the abdomen showed multiple air fluid levels and ultrasound of the abdomen revealed distended bowel loops. On exploration small bowel was found to be gangrenous. The patient was successfully managed by supportive treatment and conventional intravenous Amphotericin-B for 2 weeks. The lady was discharged one week after completion of antifungal therapy and one month later she underwent toilet mastectomy. The lady came to follow up for 1 year and she is currently under hormone therapy.
With the emergence of new and powerful immunosuppressive, anticancer drugs and potent antibiotics the survival of transplant and critically ill patients has remarkably increased but it has shown a significant rise in the incidence of invasive opportunistic fungal infections. We conclude hat the diagnosis of invasive gastrointestinal aspergillosis may be considered in a neutropenic patient with acute abdominal symptoms.
报告一名45岁女性因侵袭性曲霉病出现空肠近端坏疽。该患者正在接受晚期乳腺癌（IV期）的辅助化疗。
患者因急性腹部症状6小时被转诊至我们的外科急诊。组织病理学显示肠壁坏死和烟曲霉血管侵袭。术后恢复顺利，患者接受两性霉素B（1毫克/千克/天）治疗侵袭性曲霉病。通过从支气管肺泡灌洗中分离出烟曲霉和循环半乳甘露聚糖试验（ELISA检测）呈阳性确诊侵袭性肺曲霉病。
详细病史显示干咳和咯血发作两次，持续2周。血常规检查显示贫血和中性粒细胞减少。腹部平片显示多个气液平面，腹部超声显示肠袢扩张。探查发现小肠坏疽。患者通过支持治疗和常规静脉注射两性霉素B成功治疗2周。抗真菌治疗完成1周后患者出院，1个月后接受乳房切除清理术。该女性前来随访1年，目前正在接受激素治疗。
随着新型强效免疫抑制剂、抗癌药物和强效抗生素的出现，移植患者和重症患者的生存率显著提高，但侵袭性机会性真菌感染的发生率也显著上升。我们得出结论，对于有急性腹部症状的中性粒细胞减少患者，可考虑诊断侵袭性胃肠道曲霉病。
