Mohite U, Kell J, Haj M A, O'Brien C, Kundu S, Rees J, Burnett A K
Department of Haematology, University of Wales, Cardiff, UK.
Eur J Haematol. 2007 Mar;78(3):270-3. doi: 10.1111/j.1600-0609.2006.00812.x.
Primary gut involvement by Aspergillus is an exceedingly rare and often a fatal complication of intensive chemotherapy in patients with acute leukaemia. We report a 46-yr-old patient with granulocytic sarcoma of the testis. He received acute myeloid leukaemia type treatment with ADE chemotherapy (Cytosine Arabinoside, Daunorubicin and Etoposide). While neutropenic he presented with pyrexia, abdominal pain and massive abdominal distention. He was treated with intravenous antibiotics and antifungals according to our usual institutional protocol without any response. He was found to have toxic megacolon on plain X-ray and subsequently underwent total colectomy and ileostomy. The colon histology showed Aspergillus fungal hyphae infiltrating the bowel wall. There was no any evidence of pulmonary, hepatic, splenic or renal lesions on the computerised tomography scan. Following colectomy, he was treated with 2 wk of antifungal treatment. He recovered well and was discharged home. The increased awareness, high degree of clinical suspicion of unusual presentation and early surgical intervention with aggressive antifungal treatment, has a key role in the management of these rare and often fatal cases.
曲霉菌对肠道的原发性侵犯是急性白血病患者强化化疗极其罕见且往往致命的并发症。我们报告一名46岁患有睾丸粒细胞肉瘤的患者。他接受了ADE化疗（阿糖胞苷、柔红霉素和依托泊苷）治疗急性髓系白血病。在中性粒细胞减少期间，他出现发热、腹痛和腹部明显膨隆。按照我们医院的常规方案，他接受了静脉抗生素和抗真菌药物治疗，但没有任何效果。腹部平片显示他患有中毒性巨结肠，随后接受了全结肠切除术和回肠造口术。结肠组织学检查显示曲霉菌菌丝浸润肠壁。计算机断层扫描未发现肺部、肝脏、脾脏或肾脏有任何病变迹象。结肠切除术后，他接受了两周的抗真菌治疗。他恢复良好并出院回家。提高认识、高度临床怀疑异常表现以及早期手术干预并积极进行抗真菌治疗，在这些罕见且往往致命病例的管理中起着关键作用。
