Embolizing pulmonary aspergillosis, mycobacterial & aspergillous splenic abscess and cytomegalovirus co-infection following steroid induced immunosuppression: a case report

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Abstract

Background

Aspergillosis is a serious infection particularly affecting the immunodeficient host. Its co-infection with tuberculosis and cytomegalovirus has not been reported before. Embolic events are well recognized with aspergillous endocarditis and aortitis. Splenic abscess is a rare serious complication of disseminated aspergillosis and is difficult to treat. We report the first case of multiple embolic events and splenic abscess in a patient with pulmonary aspergillosis and cytomegaloviral and tuberculous co-infection, without endocarditis or aortitis.

Case presentation

Thirty-year-old male presented with fever and non-productive cough while on glucocorticoids for glomerulonephritis. He was found to have pulmonary aspergillosis and subsequently developed bilateral lower limb and cerebral fungal emboli and fungal abscess in the spleen. He had IgM and B cell deficiency and cytomegalovirus (CMV) and tuberculous co-infections. He recovered after prolonged course of antimicrobials, splenectomy and cessation of glucocorticoid therapy which also lead to the resolution of immune deficiencies.

Conclusion

This report illustrates rare combination of B and T cell suppressive effects of glucocorticoids leading to co-infections with CMV, Mycobacterium tuberculosis and Aspergillus and systemic fungal embolization from pulmonary aspergillosis.

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3293-4) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

Harsha Anuruddhika Dissanayake:

ORCID: http://orcid.org/0000-0003-3903-9917

+94 714219893 , dissanayakeha@gmail.com

Praveen Nilendra Weeratunga: prav782@yahoo.com

Panduka Karunanayake: pandukaru@mail.com

Rushika D. Lanerolle: rushikal@hotmail.com

M. V. Chandu de Silva: desilva_vipula@yahoo.com

Saroj Jayasinghe: sarojoffice@yahoo.com

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect. Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 6 August 2018

Publication date PMC-release: 6 August 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 367

Affiliations

[1 ]ISNI 0000 0004 0556 2133, GRID grid.415398.2, University Medical Unit, National Hospital of Sri Lanka, ; Colombo, Sri Lanka

[2 ]ISNI 0000000121828067, GRID grid.8065.b, Department of Clinical Medicine, Faculty of Medicine, , University of Colombo, ; Colombo, Sri Lanka

[3 ]Department of Pathology, Faculty of Medicine, Colombo, Sri Lanka

Author information

Harsha Anuruddhika Dissanayake http://orcid.org/0000-0003-3903-9917

Article

Publisher ID: 3293

DOI: 10.1186/s12879-018-3293-4

PMC ID: 6080400

PubMed ID: 30081818

SO-VID: 76a9a2f2-e84b-41e5-8017-ee799b24c209

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.