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Case Reports: Unusual presentation of more common disease/injury
Oesophageal and pulmonary invasive aspergillosis in a patient with multiple myeloma
  1. Alfredo G Puing1,
  2. Justine Ross2,
  3. Vishwas Parekh3 and
  4. Deepa D Nanayakkara1
  1. 1Division of Infectious Diseases, Department of Medicine, City of Hope National Medical Center, Duarte, California, USA
  2. 2Department of Pharmacy Services, City of Hope National Medical Center, Duarte, California, USA
  3. 3Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
  1. Correspondence to Dr Alfredo G Puing; alfredopuing{at}gmail.com

Abstract

Invasive aspergillosis (IA) is a serious fungal infection that primarily affects patients with prolonged and profound neutropenia, and compromised cell-mediated immunity. Aspergillosis of the oesophagus and gastrointestinal tract is uncommon but seen in advanced cases of disseminated IA. However, it is difficult to diagnose antemortem due to the poor specificity of the symptoms and the absence of characteristic imaging findings. Therefore, the reported cases of gastrointestinal aspergillosis have been associated with high morbidity and mortality, and frequently diagnosed postmortem. Here we present a successful outcome in a patient with relapsed and refractory multiple myeloma who had presented with febrile neutropenia, cough and dysphagia, and was diagnosed with disseminated IA comprising of pulmonary and oesophageal involvement. This case highlights the need for a high index of suspicion and the importance of invasive procedures for histopathology and molecular diagnostics to ensure an early diagnosis and therapeutic intervention.

  • infectious diseases
  • pneumonia (infectious disease)
  • infection (gastroenterology)

https://doi.org/10.1136/bcr-2021-246403

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    Footnotes

    • Twitter @alfredopuing

    • Contributors AP provided care for the patient and was responsible for the writing of this manuscript and literature review; JR edited and revised the manuscript; VP edited and revised the manuscript, and provided pathology slides and DN edited and revised the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.