Abstract
In Reply.— We thank Dr Varkey for his interest in our article. We agree that liver disease can impair host defense mechanisms and increase susceptibility to many types of infections, including aspergillosis. As Dr Varkey mentioned, we did discuss this in our article, and we agree with his caveat. However, we still believe that this patient did not have any preexisting severe liver disease, since he had no preexisting clinical or pathological stigmata of chronic liver disease and no pathological evidence of acute alcoholic hepatitis. The changes seen in the liver unrelated to the Aspergillus abscesses were probably caused by his shocklike state, which evolved over his hectic clinical course. Administration of the steroids was started, of course, after the illness was already manifest, and could not be considered causal in this case.
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