PMID- 38133714
OWN - NLM
STAT- MEDLINE
DCOM- 20240321
LR  - 20240323
IS  - 1439-0973 (Electronic)
IS  - 0300-8126 (Print)
IS  - 0300-8126 (Linking)
VI  - 52
IP  - 2
DP  - 2024 Apr
TI  - Fatal pulmonary hemorrhage, pneumothorax and skin necrosis caused by IRIS to an 
      Aspergillus flavus infection in a young patient with metamizole associated 
      agranulocytosis.
PG  - 685-690
LID - 10.1007/s15010-023-02149-x [doi]
AB  - We report the case of a young female with steroid-dependent ulcerative colitis 
      (UC) who developed a complex systemic infection with Aspergillus flavus. This 
      occurred following a UC relapse while vacationing in the Middle East, leading to 
      extended use of metamizole and subsequent agranulocytosis. On her return to 
      Germany, she was hospitalized for neutropenic sepsis and later transferred to our 
      hospital due to persistent cytopenia and suspected Hemophagocytic 
      Lymphohistiocytosis (HLH). Despite initial stabilization with targeted treatment 
      for pulmonary Aspergillus flavus infection, her condition rapidly deteriorated 
      following the onset of an Immune Reconstitution Inflammatory Syndrome (IRIS), 
      which manifested as skin necrosis and pneumothorax after the replenishment of 
      neutrophil granulocytes. The patient eventually died from an unmanageable 
      pulmonary hemorrhage. Microscopy of skin necroses showed a massive presence of 
      Aspergillus flavus, but tissue culture remained negative, suggesting effective 
      antifungal treatment yet delayed phagocytosis due to agranulocytosis. This case 
      underscores the need to consider IRIS in immunosuppressed patients who worsen 
      despite aggressive and appropriately targeted treatment, highlighting its 
      potential beyond the commonly recognized context in HIV-positive patients.
CI  - (c) 2023. The Author(s).
FAU - Banz, Micha
AU  - Banz M
AD  - Institute of Infectious Diseases and Infection Control, Jena University Hospital, 
      Jena, Germany. micha.banz@med.uni-jena.de.
FAU - Stallmach, Andreas
AU  - Stallmach A
AD  - Department of Gastroenterology, Hepatology and Infectology, Jena University 
      Hospital, Jena, Germany.
FAU - Gassler, Nikolaus
AU  - Gassler N
AD  - Institute of Pathology, Jena University Hospital, Jena, Germany.
FAU - Schulze, P Christian
AU  - Schulze PC
AD  - Department of Cardiology, Angiology, and Pulmonology, Jena University Hospital, 
      Jena, Germany.
FAU - Fritzenwanger, Michael
AU  - Fritzenwanger M
AD  - Department of Cardiology, Angiology, and Pulmonology, Jena University Hospital, 
      Jena, Germany.
FAU - Cornely, Oliver
AU  - Cornely O
AD  - Department I of Internal Medicine, Faculty of Medicine and University Hospital 
      Cologne, Excellence Center for Medical Mycology, Cologne, Germany.
FAU - Kurzai, Oliver
AU  - Kurzai O
AD  - Institute for Hygiene and Microbiology, University of Wurzburg, Wurzburg, 
      Germany.
FAU - Pletz, Mathias W
AU  - Pletz MW
AD  - Institute of Infectious Diseases and Infection Control, Jena University Hospital, 
      Jena, Germany.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20231222
PL  - Germany
TA  - Infection
JT  - Infection
JID - 0365307
RN  - 6429L0L52Y (Dipyrone)
SB  - IM
MH  - Humans
MH  - Female
MH  - Aspergillus flavus
MH  - *Pneumothorax
MH  - Dipyrone
MH  - *Aspergillosis/complications/drug therapy
MH  - *Lung Diseases
MH  - Hemorrhage
MH  - *Sepsis
MH  - *Agranulocytosis
MH  - Necrosis
MH  - *Lymphohistiocytosis, Hemophagocytic/microbiology
PMC - PMC10955021
OTO - NOTNLM
OT  - Aspergillus flavus
OT  - Hemophagocytic lymphohistiocytosis (HLH)
OT  - Immune reconstitution inflammatory syndrome (IRIS)
OT  - Immunosuppression
OT  - Invasive fungal disease
OT  - Ulcerative colitis
COIS- The authors declare no competing financial or non-financial interests that could 
      have appeared to influence the work reported in this paper.
EDAT- 2023/12/22 12:42
MHDA- 2024/03/21 12:43
PMCR- 2023/12/22
CRDT- 2023/12/22 11:14
PHST- 2023/10/11 00:00 [received]
PHST- 2023/11/27 00:00 [accepted]
PHST- 2024/03/21 12:43 [medline]
PHST- 2023/12/22 12:42 [pubmed]
PHST- 2023/12/22 11:14 [entrez]
PHST- 2023/12/22 00:00 [pmc-release]
AID - 10.1007/s15010-023-02149-x [pii]
AID - 2149 [pii]
AID - 10.1007/s15010-023-02149-x [doi]
PST - ppublish
SO  - Infection. 2024 Apr;52(2):685-690. doi: 10.1007/s15010-023-02149-x. Epub 2023 Dec 
      22.