Invasive aspergillosis associated with systemic lupus erythematosus and cardiac postoperative complication
A 34-year-old woman was diagnosed with systemic lupus erythematosus and treated with glucocorticoids over a period of two years. Following improvement in clinical and laboratorial tests, she was discharged. Four months later, the patient presented intense abdominal pain, high fever and renal failure. She was submitted to continuous peritoneal dialysis and developed a suggestive fungal peritonitis.\nDirect examination of fresh abdominal fluid (peritoneal effluent) revealed broad septate dichotomously branched hyphae. Cultures on routine media such as Sabouraud dextrose agar with 50 mg chloranphenicol/L were incubated at room temperature and at 37ºC, exhibiting after 48h growth suggestive of Aspergillus. Macroscopically the culture produced a flat, white colony that quickly became gray-green with the conidia production. The texture varied from strictly velvety to deep felt, floccose. The reverse was colorless. Conidia mass of the conidial heads were columnar and compact. They ranged in size from 200 to 400 μ by 50 μ. Microscopically, conidiophores were short, smooth, and up to 300 μ in length and 5 to 8 μ in diameter (). Identification of A. fumigatus was performed according to the criteria developed by Hoog et al. () and Rapper and Fennel ().\nAs soon as the diagnosis of fungal peritonitis was confirmed, amphotericin B (1 mg/kg/day) was given intravenously in increasing doses up to a total dose of 1.13g. The peritoneal catheter was removed and the patient was successfully treated.\nAspergillus peritonitis had occurred as a complication of chronic ambulatory peritoneal dialysis (,,) and the removal of the dialysis catheter was essential for eradicating the infection (). According to the literature, antifungal therapy involving both intraperitoneal and systemic amphotericin B, as well as itraconazole should be used (,,).