2009 Volume 50 Issue 12 Pages 711-718
A 66-year-old Japanese woman was referred to our hospital because of acute severe hepatitis B with acute renal dysfunction. She developed grade II encephalopathy on hospital day 2, and was diagnosed as having fulminant hepatitis B. She recovered from acute hepatic failure with intensive treatment, including artificial liver support, antiviral drugs such as entecavir and interferon-beta, and corticosteroid pulse therapy. However, multiple round lesion were detected in both lungs and a right renal mass was also found. The renal lesion was aspirated for drainage and aspergillus (Asp) was detected. Therefore, she was diagnosed as having invasive pulmonary Aspergillosis (IPA) with a retroperitoneal abscess and a subcutaneous nodule. Thereafter, her fever persisted, and pneumothorax and cerebral hemorrhage occurred together on the next day. Despite recovery from those complication, subarachnoid hemorrhage with involvement of the bilateral ventricles occurred and she died on hospital day 75. Asp is an opportunistic fungal pathogen that can cause fetal IPA in immunocompromised individuals. Since it is difficult to detect Asp early, the prognosis is usually poor even if intensive anti-fungal therapy is performed. Monitoring and prophylactic anti-fungal therapy should be recommended for high-risk patients.
