Disseminated aspergillosis in an immunocompetent patient with detectable bis(methylthio)gliotoxin and negative galactomannan / Aspergilosis diseminada en un paciente inmunocompetente con bis(metiltio)gliotoxina detectable y galactomanano negativo

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 (AU)

Antecedentes. La aspergilosis diseminada invasiva es un hallazgo excepcional en pacientes inmunocompetentes, y al igual que en los pacientes inmunodeficientes, alcanza valores de mortalidad elevados. Para el correcto manejo del paciente son necesarios métodos diagnósticos precoces. La bis(metiltio)gliotoxina es un nuevo biomarcador de gran utilidad en pacientes oncohematológicos. Caso clínico. Varón de 70 años de edad con diabetes mellitus tipo II no dependiente de insulina y antecedente de recambio valvular aórtico con by-pass coronario cinco años antes, que acude al Servicio de Urgencias por visión borrosa. Tres días después se le diagnosticó endoftalmitis endógena en la consulta de Oftalmología. Durante su ingreso para la vitrectomía presentó una isquemia del miembro inferior derecho. La tomografía computarizada de tórax reveló un aneurisma micótico en la aorta torácica ascendente y un trombo parietal. Se reemplazó la aorta ascendente y se eliminó abundante material friable de aspecto infeccioso entre la prótesis valvular aórtica y el aneurisma. En los cultivos de humor vítreo y aorta creció Aspergillus fumigatus sensu stricto. Se detectó bis(metiltio)gliotoxina en dos muestras de suero obtenidas antes del tratamiento antifúngico intravenoso, marcador que disminuyó tras comenzar el tratamiento con voriconazol. Conclusiones. La aspergilosis diseminada invasiva es una enfermedad grave independientemente del estado inmune del paciente. Este caso clínico evidencia que la bis(metiltio)gliotoxina podría ser un marcador diagnóstico precoz no solo en pacientes neutropénicos, sino también en huéspedes inmunocompetentes (AU)

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

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.