Invasive gastrointestinal aspergillosis in an ICU patient with perforated diverticulitis: risk factors and management challenges

Abstract

An immunocompetent man in his 60s was treated in the emergency department with prednisone and doxycycline for suspected contact dermatitis and superimposed cellulitis. Two days later, he returned with abdominal pain, scrotal swelling, and progressive rash. Imaging revealed perforated diverticulitis extending into the right testicle. He was managed with broad-spectrum antibiotics and underwent an exploratory laparotomy. An elevated serum galactomannan level was noted but deemed clinically insignificant, as he was not considered a typical host for an invasive mold infection. He required additional surgeries, with pathology eventually showing necrosis and fungal hyphae consistent withAspergillusspecies infiltrating the small bowel with associated angioinvasion. He was started on combination antifungal therapy with voriconazole and micafungin, followed by liposomal amphotericin B. The patient ultimately died from invasive gastrointestinal aspergillosis (IGIA). This case report explores the risk factors, clinical course, and treatment of IGIA in an intensive care unit patient who was otherwise immunocompetent.