Yıl: 2022 Cilt: 32 Sayı: 3 Sayfa Aralığı: 481 - 487 Metin Dili: İngilizce DOI: 10.4274/terh.galenos.2021.70846 İndeks Tarihi: 08-05-2023

Invasive Aspergillosis of the Small Bowel in a Patient with Acute Lymphoblastic Leukemia: Case Report and a Systematic Review of the Literature

Öz:
In invasive aspergillosis (IA), which is among the opportunistic infections in immunocompromised individuals, high rates of morbidity and mortality can be observed. This disease is most commonly seen in the respiratory tract, but has also been reported in the sinuses, central nervous system, skin, liver, and urinary tract. Aspergillosis, which can be seen outside the lung, is usually seen in disseminated disease. Although aspergillosis, which can be seen in the gastrointestinal tract, is the least common form, it may progress with complications in the follow-up. We present a patient who was followed up with the diagnosis acute leukemia and developed small bowel ileus due to IA after pulmonary aspergillosis while chemotherapy was continuing. We presented our case in a literature review. Pulmonary aspergillosis due to aspergillus was detected in a 3-year-old patient, who was diagnosed with acute lymphoblastic leukemia and relapsed while chemotherapy was continuing. The patient, who was started antifungal due to pulmonary aspergillosis, developed complaints of fever and vomiting in the follow-up. Physical examination revealed distension, defense, and tenderness in the abdominal examination. In the patient who underwent laparotomy, multiple necrotic segments were detected in the terminal jejunum and proximal ileum during the operation. Pathologically, aspergillus was detected in the resected area. Voriconazole and caspofungin were added to the patient who underwent ileum resection, but the patient died. At the time of the literature search, 12 articles on intestinal aspergillus were found. Gastrointestinal manifestations of aspergillosis may not be very specific, except for abdominal pain. If the patient has a prolonged neutropenic period, acute abdomen, gastrointestinal aspergillosis should be kept in mind even if there is no pulmonary involvement. Antifungal treatment should be started in the early period and surgical intervention should be considered in the early period for patients with acute abdomen and ileus. Dual therapy in antifungal therapy, such as combination therapy with caspofungin and voriconazole, is controversial.
Anahtar Kelime:

Akut Lenfoblastik Lösemili Bir Hastada İnce Bağırsağın İnvazif Aspergillozisi: Olgu Sunumu ve Literatür İncelemesi

Öz:
Genellikle immün yetmezliği olan konakçılarda fırsatçı bir enfeksiyon olarak görülen invaziv aspergilloz (IA), yüksek morbidite ve mortalite ile ilişkilidir. IA, izole olarak solunum sisteminde, nazal sinüslerde, merkezi sinir sisteminde, deride, karaciğerde ve idrar yollarında ortaya çıkar. Extrapulmoner aspergilloz ise genellikle dissemine olarak görülür. Gastrointestinal aspergillozis, IA’nın en az görülen şekli olmasına rağmen ciddi sonuçlara neden olabilir. Bu yazıda, kemoterapi alan ve pulmoner aspergilloz gelişen akut lösemili bir hastada IA’ya bağlı ince bağırsak ileus olgusunu sunduk. Literatürün de sistematik bir incelemesini yaptık. Kemoterapi altında dirençli ve nüks akut lenfoblastik lösemili 3 yaşında bir kız çocuğunda kemoterapiye bağlı şiddetli nötropeni ve pulmoner aspergilloz gelişti. Hasta, ateş ve kusma ile başvurdu. Muayenede soluk görünümde ve batın aşırı derecede distandü, hassas idi. Laparotomi sırasında terminal jejunum ve proksimal ileumda çoklu nekrotik segment saptandı. Aspergillus nekrotik segmentten izole edildi. İleum rezeksiyonu yapıldı. Hastaya vorikonazol ve kaspofungin uygulanmasına rağmen hasta kaybedildi. Literatür derlemesinden bağırsak IA ile ilgili daha önce tek olgu raporlarında veya küçük olgu serilerinde yayınlanmış 12 makale incelendi. Gastrointestinal aspergillozda klinik belirtiler genellikle karın ağrısı gibi non-spesifiktir ve nadiren akut batın görülür. Akciğer tutulumu olan veya olmayan şiddetli ve uzun süreli nötropenik hastalarda doğru tedavi ve acil cerrahi uygulanabilmesi açısından gastrointestinal aspergillozdan şüphelenilmelidir. Bu yazıda, erken cerrahi müdahalenin ve kombine antifungal tedavinin önemini vurgulanmaktadır. Bununla birlikte, antifungal ajanlarla kombinasyon tedavisi, özellikle kaspofungin ve vorikonazol ile kombinasyon tedavisi ile ilgili verilerin tartışmalı olduğu ve prospektif çalışmalara ihtiyaç olduğu vurgulanmalıdır.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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APA Eroğlu N, Bahadir A, ERDURAN E, KAYA G, Yalçın Cömert H, saygın i, Gayretli Aydin Z (2022). Invasive Aspergillosis of the Small Bowel in a Patient with Acute Lymphoblastic Leukemia: Case Report and a Systematic Review of the Literature. , 481 - 487. 10.4274/terh.galenos.2021.70846
Chicago Eroğlu Nilgün,Bahadir Aysenur,ERDURAN Erol,KAYA GÜLAY,Yalçın Cömert Hatice Sonay,saygın ismail,Gayretli Aydin Zeynep Gokce Invasive Aspergillosis of the Small Bowel in a Patient with Acute Lymphoblastic Leukemia: Case Report and a Systematic Review of the Literature. (2022): 481 - 487. 10.4274/terh.galenos.2021.70846
MLA Eroğlu Nilgün,Bahadir Aysenur,ERDURAN Erol,KAYA GÜLAY,Yalçın Cömert Hatice Sonay,saygın ismail,Gayretli Aydin Zeynep Gokce Invasive Aspergillosis of the Small Bowel in a Patient with Acute Lymphoblastic Leukemia: Case Report and a Systematic Review of the Literature. , 2022, ss.481 - 487. 10.4274/terh.galenos.2021.70846
AMA Eroğlu N,Bahadir A,ERDURAN E,KAYA G,Yalçın Cömert H,saygın i,Gayretli Aydin Z Invasive Aspergillosis of the Small Bowel in a Patient with Acute Lymphoblastic Leukemia: Case Report and a Systematic Review of the Literature. . 2022; 481 - 487. 10.4274/terh.galenos.2021.70846
Vancouver Eroğlu N,Bahadir A,ERDURAN E,KAYA G,Yalçın Cömert H,saygın i,Gayretli Aydin Z Invasive Aspergillosis of the Small Bowel in a Patient with Acute Lymphoblastic Leukemia: Case Report and a Systematic Review of the Literature. . 2022; 481 - 487. 10.4274/terh.galenos.2021.70846
IEEE Eroğlu N,Bahadir A,ERDURAN E,KAYA G,Yalçın Cömert H,saygın i,Gayretli Aydin Z "Invasive Aspergillosis of the Small Bowel in a Patient with Acute Lymphoblastic Leukemia: Case Report and a Systematic Review of the Literature." , ss.481 - 487, 2022. 10.4274/terh.galenos.2021.70846
ISNAD Eroğlu, Nilgün vd. "Invasive Aspergillosis of the Small Bowel in a Patient with Acute Lymphoblastic Leukemia: Case Report and a Systematic Review of the Literature". (2022), 481-487. https://doi.org/10.4274/terh.galenos.2021.70846
APA Eroğlu N, Bahadir A, ERDURAN E, KAYA G, Yalçın Cömert H, saygın i, Gayretli Aydin Z (2022). Invasive Aspergillosis of the Small Bowel in a Patient with Acute Lymphoblastic Leukemia: Case Report and a Systematic Review of the Literature. İzmir Tepecik Eğitim Hastanesi Dergisi, 32(3), 481 - 487. 10.4274/terh.galenos.2021.70846
Chicago Eroğlu Nilgün,Bahadir Aysenur,ERDURAN Erol,KAYA GÜLAY,Yalçın Cömert Hatice Sonay,saygın ismail,Gayretli Aydin Zeynep Gokce Invasive Aspergillosis of the Small Bowel in a Patient with Acute Lymphoblastic Leukemia: Case Report and a Systematic Review of the Literature. İzmir Tepecik Eğitim Hastanesi Dergisi 32, no.3 (2022): 481 - 487. 10.4274/terh.galenos.2021.70846
MLA Eroğlu Nilgün,Bahadir Aysenur,ERDURAN Erol,KAYA GÜLAY,Yalçın Cömert Hatice Sonay,saygın ismail,Gayretli Aydin Zeynep Gokce Invasive Aspergillosis of the Small Bowel in a Patient with Acute Lymphoblastic Leukemia: Case Report and a Systematic Review of the Literature. İzmir Tepecik Eğitim Hastanesi Dergisi, vol.32, no.3, 2022, ss.481 - 487. 10.4274/terh.galenos.2021.70846
AMA Eroğlu N,Bahadir A,ERDURAN E,KAYA G,Yalçın Cömert H,saygın i,Gayretli Aydin Z Invasive Aspergillosis of the Small Bowel in a Patient with Acute Lymphoblastic Leukemia: Case Report and a Systematic Review of the Literature. İzmir Tepecik Eğitim Hastanesi Dergisi. 2022; 32(3): 481 - 487. 10.4274/terh.galenos.2021.70846
Vancouver Eroğlu N,Bahadir A,ERDURAN E,KAYA G,Yalçın Cömert H,saygın i,Gayretli Aydin Z Invasive Aspergillosis of the Small Bowel in a Patient with Acute Lymphoblastic Leukemia: Case Report and a Systematic Review of the Literature. İzmir Tepecik Eğitim Hastanesi Dergisi. 2022; 32(3): 481 - 487. 10.4274/terh.galenos.2021.70846
IEEE Eroğlu N,Bahadir A,ERDURAN E,KAYA G,Yalçın Cömert H,saygın i,Gayretli Aydin Z "Invasive Aspergillosis of the Small Bowel in a Patient with Acute Lymphoblastic Leukemia: Case Report and a Systematic Review of the Literature." İzmir Tepecik Eğitim Hastanesi Dergisi, 32, ss.481 - 487, 2022. 10.4274/terh.galenos.2021.70846
ISNAD Eroğlu, Nilgün vd. "Invasive Aspergillosis of the Small Bowel in a Patient with Acute Lymphoblastic Leukemia: Case Report and a Systematic Review of the Literature". İzmir Tepecik Eğitim Hastanesi Dergisi 32/3 (2022), 481-487. https://doi.org/10.4274/terh.galenos.2021.70846