Fatal necrotizing esophagitis due toPenicillium chrysogenum in a patient with acquired immunodeficiency syndrome

Abstract

Although blue-green molds of the genus Penicillium are ubiquitous in the human environment, invasive penicilliosis is uncommon and primarily encountered among immunosuppressed patients. A patient with HIV infection who died of severe necrotizing esophagitis caused by Penicillium chrysogenum is reported and the relevant English language literature on human penicilliosis is reviewed. Although infectious esophagitis is commonly associated with AIDS, Penicillium esophagitis has not been described in such patients.

Acute esophageal necrosis: a rare syndrome

“…Cirrhosis (7) Anemia (18) Epigastric pain (10) Elective surgery (3) Renal insuffi ciency or Pneumonia (16) Dysphagia (6) Pancreatitis (3) failure (7) S/p surgery (15) GI bleeding (5) Ruptured aneurysm (2) Congestive heart Nasogastric tube (15) Low-grade fever (4) Motor vehicle accident (2) failure (6) Leukocytosis (14) Vomiting (3) Acute pulmonary edema (2) Stroke (6) Alcohol abuse (5) Abdominal pain (3) Ischemic colitis (2) Atrial fi brillation (5) Fever (5) Hypotension (2) Bone fracture (2) Pancreatitis (3) Hypotension (4) Dyspnea (2) Gastric outlet (2) Debilitation (3) Urinary tract infection (4) Refl ux (2) Obstruction (2) Chole(docho)lithiasis (2) Pancreatitis (4) Syncope (1) Weight loss (2) Peptic ulcer disease (2) Trauma (4) Acute anemia (1) DKA (1) Gastrinoma (1) Shock (4) Vomiting of mucous Ischemic gangrene (1) AIDS (1) Pregnancy, third trimester Cholecystitis (1) Peritonitis (2) Neoplastic abdominal pain (1) Erythema multiforme (2) Trauma (1) Acute pulmonary edema (2) Acute diarrhea (1) Ascites (2) Steven-Johnson syndrome (1) Hepatic encephalopathy (2) Dehydration (1) Cholecystitis (2) Fever (1) Disseminated intravascular Local esophageal cancer (1) coagulopathy (1) Dyspnea (1) Neutropenia (1) Shock (1) Ischemic colitis (1) Neoplastic ascites …”

“…Possible agents may include cytomegalovirus, 12 herpes simplex virus, 6 and certain types of fungus. 1,36 Detection of inclusion bodies 12 and multinucleated giant cells may aid in early diagnosis. 6 Antibiotic therapy in AEN is controversial.…”

“…Black esophagus should generally end abruptly at the Z-line, 9 but an infectious case was reported where it extended into the cardia of the stomach. 1 Biopsy material may be obtained for defi nitive histologic confi rmation, but is not required. Histologic fi ndings include the presence of necrotic debris on esophageal biopsy, necrotic mucosa without viable epithelium, and frequent submucosal involvement, occasionally extending into the muscularis propria, potentially leading to a full-thickness wall lysis.…”

Identification and Antifungal Susceptibility of Penicillium-Like Fungi from Clinical Samples in the United States

“…In contrast, P. chrysogenum has already been identified as a human pathogen associated with cutaneous and invasive infections (8,30,31). A total of 28 of our isolates were classified within section Chrysogena, including 19 identified as P. rubens, 2 identified as P. chrysogenum, and 7 that were very similar to those but which will require additional phylogenetic markers to distinguish them properly (29).…”

Comment on the clinical note: Acute necrotizing esophagitis in an unstable patient.

“…Coexistent BE and candidiasis should be better cleared because: reports about this association are rare 5,8,9 ; endoscopy disclose esophageal candidiasis in 1-8% of all patients examined 10 ; fungi may be opportunistic agents in immunocompromised individuals [8][9][10] , including those with APR and PEM associated with cancer or AIDS 5,8,9 . As occurred in the present case, the esophageal changes may undergo favorable resolution after management with proton pump inhibitors, sucralfate, and nutrition care, in addition to treatment of associated infections (Table 1).…”