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Isolated colonic aspergillosis in an immunocompetent individual diagnosed by metagenomic next-generation sequencing: A case report
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DOI：10.3748/wjg.v32.i13.114563.png)
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Abstract
En 中文
BACKGROUND Invasive aspergillosis (IA) is typically considered an opportunistic pulmonary infection in immunocompromised hosts. Its occurrence in immunocompetent individuals, particularly as an isolated infection of the lower gastrointestinal tract, is exceedingly rare. Such cases are frequently misdiagnosed as inflammatory bowel disease or other infectious enteritides, leading to delays in appropriate treatment. To the best of our knowledge, only 2 cases of primary (or isolated) intestinal aspergillosis (PA) have been reported in the English literature. CASE SUMMARY We report a case of a 48-year-old male, who previously underwent thyroidectomy for thyroid cancer but lacked the typical risk factors for IA. He presented to our hospital with refractory diarrhea accompanied by a 6 kg weight loss. Initial colonoscopy revealed erosions in the transverse colon. Routine blood tests and standard microbiological investigations (including bacterial cultures, parasite screening, and tuberculosis testing) were negative. Empirical antibiotic therapy and conventional symptomatic management proved ineffective. Ultimately, metagenomic next-generation sequencing (mNGS) of colonic biopsy tissue detected a relatively high abundance of Aspergillus fumigatus. Diarrhea ceased completely within 48 hours of initiating oral voriconazole therapy. A total treatment course of 12 days was administered, and the patient remained symptom-free during a 2-month follow-up period without recurrence. CONCLUSION For immunocompetent patients with refractory diarrhea, PA should be considered and mNGS-guided antifungals should be initiated.
Keywords:
Invasive aspergillosis
Primary intestinal aspergillosis
Immunocompetent individual
Voriconazole
Metagenomic next-generation sequencing
Case report
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