Oesophageal and pulmonary invasive aspergillosis in a patient with multiple myeloma

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.

Keywords: infection (gastroenterology); infectious diseases; pneumonia (infectious disease).

Figure 1

(A) Coronal chest CT reconstruction (lung window) showing a large lingular consolidation as well as a right upper and middle lobe focal consolidation. (B) Repeat chest CT 3 months later shows near complete resolution of pulmonary consolidations.

Figure 2

(A) Upper endoscopy showing a clean-based ulcer in the distal oesophagus. (B) Repeat upper endoscopy performed 6 weeks later shows an irregular Z-line with resolution of distal oesophageal ulcer.

Figure 3

H&E stained oesophageal biopsy (×200 magnification) showing septated hyphae with acute-angle-branching suggestive of Aspergillus spp.

Figure 4

Gomori methenamine-silver (GMS) stain (×400 magnification) highlighting fungal hyphae.