Invasive Pulmonary Aspergillosis in Patients with Non-Decompensated Liver Cirrhosis: A Case Report

Abstract

Introduction: Invasive pulmonary aspergillosis (IPA) is a fatal disease usually occurring in patients with neutropenia resulted from chemotherapy for malignancy. The other risk factors include consuming corticosteroids, organ transplant and advanced acquired immunodeficiency syndrome (AIDS). Recently, the incidence of IPA in immunocompetent patients without any history of organ transplant or malignancy has been increasing. Patients with advanced cirrhosis are one of the cases involved in this infection. Case Presentation: In this case study, we report invasive pulmonary aspergillosis in a 50-year-old patient (from Sari, Iran), who had gradual abdominal pain and ascites, cough and respiratory distress. Radiographic signs showed a round infiltration in the upper part of the right lung. Despite receiving 48-hour antibiotics therapy, the fever had not subsided. In CT-guided needle lung biopsy, septate and acutely angled hyphae (dichotomous) were seen. In CT-guided needle lung biopsy, septate and acutely angled hyphae (dichotomous) were seen. Direct examination of the sputum showed septate hyphae compatible with a filamentous fungus. According to morphological and molecular characterization, Aspergillus fumigatus was confirmed. Minimum inhibitory concentration (MIC) values of antifungal agents were determined based on the clinical and laboratory standard institute (CLSI) M38-A2. Treatment with intravenous amphotericin B was changed to oral voriconazole 200 mg, twice a day. The patient did not have any kind of residual lung lesion within the six-month follow-up and the cirrhosis was under control and she currently has no respiratory symptoms or signs. Conclusions: In patients with liver cirrhosis, when there is evidence of severe pulmonary disease without proper response to treatment, the possibility of invasive pulmonary fungal infection should be considered.

Cryptococcal Meningitis in An Immunocompetent Patient

“…The doctor could wrongly believe that the patient has a chronic illness rather than an acute pathology when individuals who don't have the clear risk factors for cryptococcal meningitis arrive with hazy symptoms or repeatedly with the same symptoms, including headache. Thus, in otherwise healthy, immunocompetent individuals, anchoring bias presents a significant challenge to the rapid and accurate detection of cryptococcal meningitis [10].…”