Gangrene Research Today is a free monthly online journal that collates and summarizes the latest research about Gangrene, including details on smoking, treatment, causes, amputation, necrosis.

Invasive aspergillosis causing small bowel infarction in a patient of carcinoma breast undergoing chemotherapy.

Chaudhary A, Jain V, Dwivedi RS, Misra S

Department of Surgery, King George Medical University, Lucknow, India. amitwtc@yahoo.co.in.

ABSTRACT: BACKGROUND: 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). METHODS: 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). RESULTS: 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. CONCLUSION: 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.

Published 24 July 2006 in J Carcinog, 5: 18.
Full-text of this article is available online (may require subscription).

© 2005-2008 Gangrene Research Today. All Rights Reserved.