Invasive aspergillosis

1.4% in 2315 consecutive necropsies

In immunocompromised patients 11%

Boom AP,et al. J Clin Pathol 1991;44:452-4

症例報告• Tresallet C, Nguyen-Thanh Q, Aubriot-Lorton MH, Akakpo JP, Al Jijakli A, Card

ot V, Chigot JP, Menegaux F. Small-bowel infarction from disseminated aspergillosis. Dis Colon Rectum. 2004 Sep;47(9):1515-8

• Neutropenic patients

• 主訴：腹痛と腹満、発熱

• CT findings ： diffuse, small-bowel distention with a thickened, distal, ileum wall. Emergency surgery was performed with resection and immediate anastomosis of the distal ileum. Pathology of the small bowel showed a wall necrosis and invasion by Aspergillus fumigatus.

Abdominal CT

Contrast enhanced axial CT scan shows diffuse small-bowel distention with a thickened wall of the distal ileum, a target sign (arrow), and an inflammation of the perienteric fat.

Macroscopy of the small bowel

shows irregular mucosal ulcerations with disseminated necrosis areas, and a thick, grey, necrotic debris recovering mucosa.

Pathological findings

Microscopy of the surgical specimen from the ileal resection demonstrates transmural infarction with fibrin deposits recovering mucosa (hematoxylin and eosin; original magnification Å~2.5).

Pathological findings (Grocott’s)

Aspergillus fumigatus hyphal elements massively invade the wall of a submucosal muscular artery (Grocotts methenamine silver; original magnification Å~40).

The disseminated invasive aspergillosis of the alimentary tract

診断：1. 症状が nonspecific

2. 腹痛、発熱3. 腹部 CT

4. 病理組織ー内視鏡治療：1. 抗真菌剤2. 切除3. Poor prognosis