Cha Seon Ah, Kim Mi Hee, Lim Tae Seok, Kim Hyun Ho, Chang Kyung Yoon, Park Hoon Suk, Kim Hyung Wook, Wie Seong Heon, Jin Dong Chan
Department of Internal Medicine, School of Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea.
Yonsei Med J. 2015 Sep;56(5):1453-6. doi: 10.3349/ymj.2015.56.5.1453.
Invasive aspergillosis (IA), generally considered an opportunistic infection in immunocompromised hosts, is associated with high morbidity and mortality. IA commonly occurs in the respiratory tract with isolated reports of aspergillosis infection in the nasal sinuses, central nervous system, skin, liver, and urinary tract. Extra-pulmonary aspergillosis is usually observed in disseminated disease. To date, there are a few studies regarding primary and disseminated gastrointestinal (GI) aspergillosis in immunocompromised hosts. Only a few cases of primary GI aspergillosis in non-immunocompromised hosts have been reported; of these, almost all of them involved the upper GI tract. We describe a very rare case of IA involving the lower GI tract in the patient without classical risk factors that presented as multiple colon perforations and was successfully treated by surgery and antifungal treatment. We also review related literature and discuss the characteristics and risk factors of IA in the immunocompetent hosts without classical risk factors. This case that shows IA should be considered in critically ill patients, and that primary lower GI aspergillosis may also occur in the immunocompetent hosts without classical risk factors.
侵袭性曲霉病（IA）通常被认为是免疫功能低下宿主中的机会性感染，与高发病率和死亡率相关。IA常见于呼吸道，也有关于鼻窦、中枢神经系统、皮肤、肝脏和泌尿道曲霉感染的个别报道。肺外曲霉病通常在播散性疾病中观察到。迄今为止，关于免疫功能低下宿主中原发性和播散性胃肠道（GI）曲霉病的研究较少。非免疫功能低下宿主中仅报道了少数原发性胃肠道曲霉病病例；其中，几乎所有病例都累及上消化道。我们描述了一例非常罕见的IA病例，该病例发生在无典型危险因素的患者的下消化道，表现为多处结肠穿孔，通过手术和抗真菌治疗成功治愈。我们还回顾了相关文献，并讨论了无典型危险因素的免疫功能正常宿主中IA的特征和危险因素。该病例表明，重症患者应考虑IA，原发性下消化道曲霉病也可能发生在无典型危险因素的免疫功能正常宿主中。
