Eventos trombóticos asociados a infección invasiva por Aspergillus: reporte de un caso

The development of Invasive aspergillosis, which can be caused by any of the Aspergillus species, depends on the fungus itself, and the naturally immune status of the patient. The mortality of this disease exceeds 50%. The case is presented of an adult patient with no previous disease history. There was a progressive clinical picture of oedema in the lower limbs, as well as in the right arm, which had a violet coloured appearance. This was combined with dyspnoea of little effort and severe anaemia that required red cell transfusion. The arterio-venous Doppler of the limbs showed thrombosis of the whole deep venous system of the right arm, for which full anticoagulation was started. The gradually deteriorating patient was transferred to the Intensive Care Unit, where neurological impairment was detected. The computed tomography brain scan showed evidence of an ischaemic and acute haemorrhagic event. The patient died and an autopsy was performed. Although Invasive aspergillosis is more common in immunocompromised patients, there have been reports of cases in immunocompetent patients. The angio-invasion process by the hyphae increases tissue factor production that, in turn, triggers the coagulation cascade. One of the important features of this infection is the widespread intravascular thrombosis from the focus of infection. Voriconazole has proved highly effective, and should be started on clinical suspicion of the disease, since the mortality without treatment can reach 90%.