Perakute disseminiert verlaufene, tödliche Aspergillus fumigatus-Infektion bei Leberversagen und Kortikoidtherapie

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Abstract
Cytostatic-treated persons and cases of severe hepatic failure under corticoid therapy are predisposed to disseminating Aspergillus infections. Constant exposure to Aspergillus spores may result in a fatal Aspergillus infection. The triad of hepatic failure, corticoid therapy and constant exposure to Aspergillus spores is described in a 70-year-old female patient. A painless icterus was clinically diagnosed as non-A non-B hepatitis, with a protracted cholestatic course. She had been treated with an oral corticoid preparation. After leaving the hospital at her own insistance when still in the icteric stage, severe pneumonia due to Aspergillus developed within 14 days; this was confirmed radiologically. The autopsy results showed unexpected infarction, similar to pneumonic foci, in all lobes and dissemination in the myocardium, stomach, kidneys and brain. The liver showed subacute dystrophy. Constant exposure to the conidia of A fumigatus came about as a result of the soil of potted ornamental plants in the patient's living room. The fungus could only be successfully cultured by putting infected tissue particles on Sabouraud dextrose agar; it was not possible by the common method of fractionated streaking.