Tay MH, Balram C, Foo KF, Busmanis I, Raman S, Khoo KS. Unusual case of bowel infarction with invasive Aspergillus in an immunocompromised patient.
Ann Acad Med Singap 2003;
32:122-5. [PMID:
12625110]
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Abstract
INTRODUCTION
We report a patient with bowel infarction due to invasive Aspergillus infection as a result of prolonged chemotherapy-induced neutropenia.
CLINICAL PICTURE
The patient was given neoadjuvant chemotherapy with doxorubicin, docetaxel, and capecitabine for a breast tumour. She developed prolonged neutropenia, Escherichia coli and Candida krusei sepsis, acute arterial thrombosis of the left lower limb, and invasive aspergillus infection.
TREATMENT
She underwent a subtotal colectomy, small intestine resection and an above-knee amputation.
OUTCOME
The hospitalisation was complicated with methicillin-resistant Staphylococcus aureus pneumonia and short gut syndrome. She subsequently underwent simple mastectomy with axillary clearance and received adjuvant chemotherapy and radiation without complication.
CONCLUSION
Chemotherapy should be protocol-directed. In a non-trial situation, protocol must have a sound basis, proven safety, and efficacy. Aspergillus infection is uncommon in patients with solid tumours; prompt treatment must be started on high suspicion.
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