Barrera-Herrera Luis E, Vera Alonso, Álvarez Johanna, Lopez Rocio
Pathology and Clinical Laboratory Department, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia.
Transplant Service, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia ; School of Medicine, Universidad de los Andes, Bogotá, Colombia.
Case Rep Gastroenterol. 2015 Jan 14;9(1):1-6. doi: 10.1159/000371541. eCollection 2015 Jan-Apr.
Liver transplantation is the only available treatment for some patients with end-stage liver disease. Despite reduction in mortality rates due to advances related to surgical techniques, intensive medical management and immunosuppressive therapy, invasive fungal infections remain a serious complication in orthotopic liver transplantation. We report the case of an 18-year-old male diagnosed with autoimmune cirrhosis in 2009 who was assessed and listed for liver transplantation for massive variceal hemorrhage. One year after listing a successful orthotopic liver transplantation was performed. Uneventful early recovery was achieved; however, he developed pulmonary and neurological Aspergillus infection 23 and 40 days after surgery, respectively. Antibiotic therapy with voriconazole and amphotericin was started early, with no major response. Neuroimaging revealed multiple right frontal and right parietal lesions with perilesional edema; surgical management of the brain abscesses was performed. A biopsy with periodic acid-Schiff and Gomori stains revealed areas with mycotic microorganisms morphologically consistent with Aspergillus, later confirmed by culture. The patient developed necrotizing encephalitis secondary to aspergillosis and died. Necrotizing encephalitis as a clinical presentation of Aspergillus infection in an orthotopic liver transplant is not common, and even with adequate management, early diagnosis and prompt antifungal treatment, mortality rates remain high.
肝移植是一些终末期肝病患者唯一可行的治疗方法。尽管由于手术技术、强化医疗管理和免疫抑制治疗等方面的进步，死亡率有所降低，但侵袭性真菌感染仍然是原位肝移植中的严重并发症。我们报告一例18岁男性病例，该患者于2009年被诊断为自身免疫性肝硬化，因大量静脉曲张出血接受评估并被列入肝移植名单。列入名单一年后成功进行了原位肝移植。术后早期恢复顺利；然而，他分别在术后23天和40天发生了肺部和神经系统曲霉菌感染。早期开始使用伏立康唑和两性霉素进行抗真菌治疗，但无明显效果。神经影像学检查显示右侧额叶和右侧顶叶有多个病灶，并伴有病灶周围水肿；对脑脓肿进行了手术治疗。经高碘酸-希夫染色和戈莫里染色的活检显示，存在形态上与曲霉菌一致的真菌微生物区域，后来通过培养得到证实。该患者继发曲霉菌病后发生坏死性脑炎并死亡。坏死性脑炎作为原位肝移植中曲霉菌感染的临床表现并不常见，即使进行了适当的管理、早期诊断和及时的抗真菌治疗，死亡率仍然很高。
