Aspergillus fumigatus cholangitis in a patient with cholangiocarcinoma: case report and review of the literature

Kathrin Rothe,Dirk H Busch,Wolfgang Huber,J Ulrich ,Christoph Schlag,Roland M Schmid,A Poszler ,Sebastian Rasch,Nina Wantia,Tobias Lahmer

doi:10.1007/s15010-020-01487-4

Abstract

Aspergillus spp. cholangitis is an uncommon presentation of invasive aspergillosis. Only few cases are described in the literature affecting severely immunocompromised patients or patients following biliary surgery. Especially, invasive aspergillosis in non-haematological patients is associated with high mortality rates, caused by atypical presentations, which is associated with a delay in diagnosis and therapy. We report a 72-year-old man with primary diagnosis of cholangiocarcinoma and stent implantation by endoscopic retrograde cholangiopancreatography (ERCP) for biliary decompression who developed severe cholangitis with invasive aspergillosis. The patient had no history of prior hospitalisation, no immunosuppressive therapy and no preceding biliary surgery. Furthermore, in this exceptional case of extrapulmonary aspergillosis, there were no signs of pulmonary involvement. From the literature review, only three cases of Aspergillus cholangitis could be identified. Clinical manifestations of invasive aspergillosis can be variable and classical risk factors such as immunosuppression are not mandatorily present. Clinical awareness of these rare cases is of vital importance for initiation of correct therapy.

Highlights

Aspergillus spp. are ubiquitous saprophytic environmental fungi causing human disease by inhalation or ingestion of airborne conidia, which in healthy individuals are quickly removed by mucociliary clearance and alveolar macrophages [1, 2]
The most common species of Aspergillus spp. causing invasive disease are Aspergillus (A.) fumigatus, A. flavus, A. niger, A. terreus, and A. nidulans with A. fumigatus accounting for the majority of cases of invasive aspergillosis
Mortality associated with invasive aspergillosis exceeds 50% [3, 4]

Summary

Introduction

Aspergillus spp. are ubiquitous saprophytic environmental fungi causing human disease by inhalation or ingestion of airborne conidia, which in healthy individuals are quickly removed by mucociliary clearance and alveolar macrophages [1, 2]. Classical risk factors for invasive aspergillosis in patients include haematological malignancy, neutropenia or immunosuppressive therapy (e.g. steroids), advanced AIDS (acquired immune deficiency syndrome) or advanced neoplasia, altered lung function such as COPD (chronic obstructive pulmonary syndrome) and liver failure and liver cirrhosis [2, 5, 6]. None of these risk factors was present in this special case. The patient died after 36 days on our ICU due to ongoing multiple organ dysfunction

Discussion

Conclusion

Compliance with ethical standards