INVASIVE ASPERGILLOSIS IN PATIENTS WITH CIRRHOSIS, A CASE REPORT AND REVIEW OF THE LAST 10 YEARS

Abstract

Background: Untreated invasive aspergillosis (IA) is lethal, yet diagnosis is often delayed. Recognising the risk factors can lead to earlier diagnosis.We present a case of an invasive pulmonary aspergillosis in a patient with cirrhosis, who had been treated with corticosteroids for 2.5 weeks for alcoholic hepatitis. He was successfully treated with liposomal amphotericin B and caspofungin (first in combination, then caspofungin monotherapy).Purpose: to evaluate the role of aspergillosis in cirrhosisMethods: A literature search on aspergillosis in cirrhosis and liver failure patients was conducted in PubMed/ Medline (2002-dec 2012), according to pre-set selection criteria.Results: 20 out of 330 articles were retrieved, representing 43 patients with cirrhosis and/or liver failure who had an aspergillosis infection. Most Aspergillus (A.) infections were due to A. fumigatus and the lungs were the most frequent organ involved (42/43). 58% of the patients used steroids and mortality was 53,5%. The most frequent used antifungal was caspofungin.Discussion: Diagnosis of IA is difficult and there might be a delay in diagnosis since cirrhosis is not recognised as one of the classical risk factors. Mortality was 53,5%, but this is lower than in previous decades. Since voriconazole is hepatotoxic, treatment with caspofungin and /or amphotericin is preferable.Conclusion: Early recognition of aspergillosis in a cirrhosis/ liver failure patient is crucial and should prompt direct treatment.