Invasive maxillary aspergillosis in a patient with systemic lupus erythematosus: Case report

Ann Med Surg (Lond). 2020 Sep 1;58:44-47. doi: 10.1016/j.amsu.2020.08.031. eCollection 2020 Oct.

Abstract

Introduction: Invasive aspergillosis (IA) is a fungal infection caused by Aspergillus species (spp.). Aspergillosis is the most common source of opportunistic fungal infection in humans. IA can cause serious complications related to high morbidity and mortality in immunocompromised patients.

Presentation of case: We report a case of a 22-year-old female with a chief complaint of having a hole in the roof of her mouth. She was diagnosed with SLE in 2009. She had been consuming oral methylprednisolone ever since. In 2018, she experienced worsened symptoms and was hospitalized. She experienced swelling and bleeding of her gums and some of her teeth becoming loose and falling out, and then developing a hole in the roof of her mouth. Subsequently, she was treated with oral cyclophosphamide, oral mycophenolate sodium, and oral fluconazole. She was asked to stop taking oral methylprednisolone. In 2019, the palate biopsy was performed and showed Aspergillus spp. invading the palate. Afterward, the patient was referred to our clinic for defect closure. The patient was operated on for debridement and reconstruction of the defect. There was no recurrence of the defect or complications observed in the follow-up. The patient was satisfied with the surgical results.

Discussion: IA is a destructive and potentially harmful opportunistic fungal infection and treatments with surgical interventions should be well-thought-out in immunocompromised patients.

Conclusion: The management of IA are controlling any underlying diseases and surgical debridement or necrotomy. Generally, antifungal therapy and prompt surgical intervention are successful in managing invasive aspergillosis.

Keywords: ANA, antinuclear antibodies; CT scan, computed tomography; ENT, ear, nose, and throat; FRS, fungal rhinosinusitis; GMS, Grocott-Gomori's Methenamine Silver; IA, Invasive aspergillosis; Invasive aspergillosis; MRI, magnetic resonance imaging; Maxillary defect; PAS, Periodic Acid-Schiff; Palatal defect; Plastic reconstructive surgery; SLE, systemic lupus erythematosus; Systemic lupus erythematosus; anti-dsDNA, anti-double stranded DNA.

Publication types

  • Case Reports