Characteristic clinical features of Aspergillus appendicitis:Case report and literature review

作     者：Mihajlo Gjeorgjievski Mitual B Amin Mitchell S Cappell 

作者机构：Division of Gastroenterology and Hepatology William Beaumont Hospital Anatomic Pathology William Beaumont Hospital Oakland University William Beaumont School of Medicine 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2015年第21卷第44期

页      面：12713-12721页

核心收录：

学科分类：1002[医学-临床医学] 100202[医学-儿科学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Aspergillosis Aspergillus appendicitis Fungal appe 

摘      要：This work aims to facilitate diagnosing Aspergillus appendicitis, which can be missed clinically due to its rarity, by proposing a clinical pentad for Aspergillus appendicitis based on literature review and one new case. The currently reported case of pathologicallyproven Aspergillus appendicitis was identified by computerized search of pathology database at William Beaumont Hospital, 1999-2014. Prior cases were identified by computerized literature search. Among 10980 pathology reports of pathologically-proven appendicitis, one case of Aspergillus appendicitis was identified(rate = 0.01%). A young boy with profound neutropenia, recent chemotherapy, and acute myelogenous leukemia presented with right lower quadrant pain, pyrexia, and generalized malaise. Abdominal computed tomography scan showed a thickened appendiceal wall and periappendiceal inflammation, suggesting appendicitis. Emergent laparotomy showed an inflamed, thickened appendix, which was resected. The patient did poorly postoperatively with low-grade-fevers while receiving antibacterial therapy, but rapidly improved after initiating amphotericin therapy. Microscopic examination of a silver stain of the appendectomy specimen revealed fungi with characteristic Aspergillus morphology, findings confirmed by immunohistochemistry. Primary Aspergillus appendicitis is exceptionally rare, with only 3 previously reported cases. All three cases presented with(1)-neutropenia,(2)-recent chemotherapy,(3)-acute leukemia, and(4)-suspected appendicitis;(5)-the two prior cases initially treated with antibacterial therapy, fared poorly before instituting antiAspergillus therapy. The current patient satisfied all these five criteria. Based on these four cases, a clinical pentad is proposed for Aspergillus appendicitis: clinically-suspected appendicitis, neutropenia, recent chemotherapy, acute leukemia, and poor clinical response if treated solely by antibacterial/anti-candidial therapy. Patients presenting with this propos