Oesophageal and pulmonary invasive aspergillosis in a patient with multiple myeloma

Invasive aspergillosis (IA) is a serious fungal infection that primarily affects patients with prolonged and profound neutropenia, and compromised cell-mediated immunity. Aspergillosis of the oesophagus and gastrointestinal tract is uncommon but seen in advanced cases of disseminated IA. However, it...

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Bibliographic Details
Published in:BMJ case reports 2022-03, Vol.15 (3), p.e246403
Main Authors: Puing, Alfredo G, Ross, Justine, Parekh, Vishwas, Nanayakkara, Deepa D
Format: Article
Language:English
Subjects:
Abdomen
Antigens
Aspergillosis
Aspergillosis - complications
Aspergillosis - diagnosis
Aspergillosis - drug therapy
Biopsy
Case reports
Case Reports: Unusual presentation of more common disease/injury
Chemotherapy
Disease prevention
Drug dosages
Drug interactions
Dysphagia
Endoscopy
Esophagus
Fever
Fungal infections
Hematology
Humans
Invasive Fungal Infections - complications
Invasive Pulmonary Aspergillosis - complications
Invasive Pulmonary Aspergillosis - diagnosis
Invasive Pulmonary Aspergillosis - drug therapy
Mucositis
Multiple myeloma
Multiple Myeloma - complications
Multiple Myeloma - diagnosis
Neutropenia
Pain
Patients
Stem cells
Transplants & implants
Ulcers
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Description
Summary:Invasive aspergillosis (IA) is a serious fungal infection that primarily affects patients with prolonged and profound neutropenia, and compromised cell-mediated immunity. Aspergillosis of the oesophagus and gastrointestinal tract is uncommon but seen in advanced cases of disseminated IA. However, it is difficult to diagnose antemortem due to the poor specificity of the symptoms and the absence of characteristic imaging findings. Therefore, the reported cases of gastrointestinal aspergillosis have been associated with high morbidity and mortality, and frequently diagnosed postmortem. Here we present a successful outcome in a patient with relapsed and refractory multiple myeloma who had presented with febrile neutropenia, cough and dysphagia, and was diagnosed with disseminated IA comprising of pulmonary and oesophageal involvement. This case highlights the need for a high index of suspicion and the importance of invasive procedures for histopathology and molecular diagnostics to ensure an early diagnosis and therapeutic intervention.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2021-246403