Rare Case of Colonic Perforation From Disseminated Fungal Infection in Immunocompetent Patient

Abstract

Fungal infection is a serious complication seen in immunosuppressed patients. Fungal dissemination and infection of the intestine is a rare complication noted in the literature. We report an extremely rare case of colonic perforation from dissemination fungal infection in an immunocompetent patient. A 76-year-old man presented with a 1-week history of pneumonia-like symptoms of fever, lethargy, productive cough, and night sweats. On examination he was hypotensive and hypoxic. Chest X-ray showed bilateral diffuse consolidation. Peripheral blood showed raised white cell count and inflammatory markers. His background history included chronic lymphocytic leukemia for which he has been in remission for over 7 years. Preliminary diagnosis of pneumonia was made and the patient was started on intravenous antibiotics. His condition deteriorated over the course of 3 weeks, culminating in multi-organ failure, including acute renal failure requiring dialysis, respiratory failure requiring intubation, and hypotension requiring inotropic support. Culture of bronchial washing revealed growth of Pseudomonas aeruginosa and Candida glabrata. On the 19th day of admission, the patient's condition further deteriorated with colonic perforation and feculent peritonitis. Emergency laparotomy with removal of involved colon and end colostomies were performed. Histopathology of the involved colon showed 1.5 cm perforation with inflammatory infiltration. Histopathologic staining showed angioinvasive fungal infection with Aspergillus. Aspergillus usually spreads hematogenously from the lungs. Gastrointestinal involvement is difficult to diagnose as the symptoms are often vague and masked by other systemic symptoms. Computed tomography scan can show bowel wall thickening. However, often the diagnosis is only made postoperatively.