Invasive aspergillosis in patients with cirrhosis, a case report and review of the last 10 years

Background: Untreated invasive aspergillosis (IA) is lethal, yet diagnosis is often delayed. Recognising the risk factors can lead to earlier diagnosis. We present a case of an invasive pulmonary aspergillosis in a patient with cirrhosis, who had been treated with corticosteroids for 2.5 weeks for alcoholic hepatitis. He was successfully treated with liposomal amphotericin B and caspofungin (first in combination, then caspofungin monotherapy). Purpose: to evaluate the role of aspergillosis in cirrhosis Methods: A literature search on aspergillosis in cirrhosis and liver failure patients was conducted in Pub-Med/Medline (2002-dec 2012), according to pre-set selection criteria. Results: 20 out of 330 articles were retrieved, representing 43 patients with cirrhosis and/or liver failure who had an aspergillosis infection. Most Aspergillus (A.) infections were due to A. fumigatus and the lungs were the most frequent organ involved (42/43). 58% of the patients used steroids and mortality was 53,5%. The most frequent used antifungal was caspofungin. Discussion: Diagnosis of IA is difficult and there might be a delay in diagnosis since cirrhosis is not recognised as one of the classical risk factors. Mortality was 53,5%, but this is lower than in previous decades. Since voriconazole is hepatotoxic, treatment with caspofungin and /or amphotericin is preferable. Conclusion: Early recognition of aspergillosis in a cirrhosis/liver failure patient is crucial and should prompt direct treatment.

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