Acute-on-chronic liver failure complicated by Anaerobiospirillum succiniciproducens bacteremia and invasive aspergillosis: A case report and a narrative review

Acute-on-chronic liver failure (ACLF) is a complex condition characterized by acutely decompensated cirrhosis, resulting in multi-organ failure, profound immune dysfunction and an increased risk of opportunistic and fungal infections. ACLF affects approximately one-third of patients hospitalized with cirrhosis and is associated with a high risk of short-term mortality. We present the case of a 53-years old Caucasian female admitted to the intensive care unit (ICU) with ACLF of mixed etiology, complicated by Anaerobiospirillum succiniciproducens bacteremia and invasive aspergillosis involving the central nervous system (CNS) and pulmonary system. This case report highlights the complexities of managing invasive aspergillosis in patients with ACLF, focusing on the limitations of laboratory diagnostics and radiological imaging, as well as the therapeutic challenges posed by toxicity of antifungal agents.