A Critically Ill Patient with Aspergillus Fumigatus Sepsis-Related Ischemic Colitis

Background: Invasive aspergillosis (IA) is an opportunistic infection generally encountered in patients with hematological malignancies. However, IA is increasingly recognized in non-neutropenic and critically ill patients in the absence of classic risk factors.
Case Report: An 81-year-old man with diabetes mellitus (DM), chronic renal failure (CRF), and heart failure, who had had 1-week complaints of diarrhea, nausea, and vomiting, was admitted to the intensive care unit with septic shock, acute respiratory failure, and acute kidney injury. Chest computed tomography showed cavitary lung lesions and colonoscopy revealed ischemic ulcers in the descending colon. Other causes of cavitary lung lesions were excluded and all cultures were negative, except for bronchoalveolar lavage yielding Aspergillus fumigatus. Thus, Aspergillus fumigatus sepsis with multiorgan failures was diagnosed.
Conclusion: Inhaled Aspergillus conidia are kept under control by alveolar macrophage. DM, CRF, and aging are the conditions that disrupt phagocytic activity of macrophages and predispose to IA.