Disseminated aspergillosis in an immunocompetent patient with detectable bis(methylthio)gliotoxin and negative galactomannan

Abstract Background Disseminated invasive aspergillosis is an exceptional finding in immunocompetent hosts. As in immunocompromised patients, it has high mortality rates. Early diagnostic methods are required in order to properly manage the patient. Bis(methylthio)gliotoxin (bmGT) is a novel biomark...

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Published in:Revista iberoamericana de micología 2017-01, Vol.34 (1), p.49-52
Main Authors: Vidal-García, Matxalen, Sáncehez-Chueca, Pilar, Domingo, María Pilar, Ballester, Carlos, Roc, Lourdes, Ferrer, Isabel, Revillo, María José, Pardo, Julián, Gálvez, Eva María, Rezusta, Antonio
Format: Article
Language:English
Subjects:
Aneurisma micótico
Aspergilosis diseminada
Bis(methylthio)gliotoxin
Bis(metiltio)gliotoxina
Diagnosis
Diagnóstico
Disseminated aspergillosis
Galactomanano
Galactomannan
Gliotoxin
Gliotoxina
Infectious Disease
Mycotic aneurysm
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Summary:Abstract Background Disseminated invasive aspergillosis is an exceptional finding in immunocompetent hosts. As in immunocompromised patients, it has high mortality rates. Early diagnostic methods are required in order to properly manage the patient. Bis(methylthio)gliotoxin (bmGT) is a novel biomarker, useful in onco-hematological patients. Case report A 70-year-old male, with non-insulin dependent type II diabetes mellitus and a past surgery history of aortic valve replacement with coronary by-pass five years ago, was seen in the emergency department with blurred vision. Three days later, endogen endophthalmitis was diagnosed in the ophthalmology clinic. During admission for the vitrectomy, he suffered an ischemia of the right lower limb. A thoracic computed tomography revealed a mycotic aneurysm of the ascending thoracic aorta and parietal thrombus. The ascending aorta was replaced and abundant brittle material of infectious appearance, found between the aortic valve graft and the aneurysm, was removed. Aspergillus fumigatus sensu stricto grew in both vitreous and aorta cultures. BmGT was detected in two serum samples obtained prior to intravenous antifungal treatment, which was then reduced after voriconazole treatment was started. Conclusions Disseminated invasive aspergillosis is a severe disease regardless of the immune status of the patient. This case report suggests that bmGT could be a suitable early diagnostic biomarker, not only in neutropenic patients, but also in immunocompetent hosts.
ISSN:1130-1406
DOI:10.1016/j.riam.2016.05.007