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, Cardot 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： 抗真菌剤 切除 Poor prognosis