Case report

Invasive pulmonary aspergillosis in patients with decompensated cirrhosis: case series

Hélène Prodanovic¹ , Christophe Cracco¹ , Julien Massard² , Camille Barrault³ , Dominique Thabut² , Alexandre Duguet¹ , Annick Datry⁴ , Jean-Philippe Derenne¹ , Thierry Poynard² and Thomas Similowski¹

¹  Assistance Publique – Hôpitaux de Paris, Service de Pneumologie et Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris, France

²  Assistance Publique – Hôpitaux de Paris, Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France

³  Assistance Publique – Hôpitaux de Paris, Service d'Hépato-Gastroentérologie, Hopital Henri-Mondor, Créteil, France

⁴  Assistance Publique – Hôpitaux de Paris, Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France

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BMC Gastroenterology 2007, 7:2doi:10.1186/1471-230X-7-2

Published:	31 January 2007

Abstract

Background

Opportunistic invasive fungal infections are increasingly frequent in intensive care patients. Their clinical spectrum goes beyond the patients with malignancies, and for example invasive pulmonary aspergillosis has recently been described in critically ill patients without such condition. Liver failure has been suspected to be a risk factor for aspergillosis.

Case presentation

We describe three cases of adult respiratory distress syndrome with sepsis, shock and multiple organ failure in patients with severe liver failure among whom two had positive Aspergillus antigenemia and one had a positive Aspergillus serology. In all cases bronchoalveolar lavage fluid was positive for Aspergillus fumigatus. Outcome was fatal in all cases despite treatment with voriconazole and agressive symptomatic treatment.

Conclusion

Invasive aspergillosis should be among rapidly raised hypothesis in cirrhotic patients developing acute respiratory symptoms and alveolar opacities.