Zusammenfassung
Invasive Mykosen wie zum Beispiel die Aspergillose stellen bei Patienten mit hämatologischen Systemerkrankungen eine häufige Todesursache dar. In Obduktionsstudien weist rund ein Viertel dieses Patientenguts systemische Pizinfektionen auf. Die häufigste Blutungskomplikation der Aspergillose bei pulmonalem Befall ist die Hämoptyse. Es finden sich jedoch auch Fallberichte von Beteiligung viszeraler Organe, insbesondere der Leber. Wir beschreiben einen Fall, in dem es neben einem Befall der Leber und der Niere als initialem Symptom zusätzlich zu einer septischen Gefäßarrosion der A. subclavia gekommen ist. Besonderes Augenmerk wurde hier auf die Möglichkeit der endovaskulären Versorgung dieser fulminanten Blutungskomplikation im Sinne eines „bridging“ gelegt.
Abstract
Invasive mycotic infections like aspergillosis are a major cause of death in patients with malignant haematologic diseases. Autopsy studies show that every fourth patient suffers from systemic mycotic infections. The most common cause of bleeding in aspergillosis is haemoptysis due to lung involvement, but also visceral organs like liver and kidneys are infested. We report a case of aspergillosis in which, apart from initial liver and kidney symptoms, septic arrosion of the subclavian artery also appeared. The case is described with special emphasis on the possibility of endovascular treatment as a bridging method for this fulminant complication.
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Literatur
Marr KA, Patterson T, Denning D (2002) Aspergillosis. Pathogenesis, clinical manifestations, and therapy. Infect Dis Clin North Am 16: 875–894, vi
Marr KA, Carter RA, Boeckh M et al. (2002) Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors. Blood 100: 4358–4366
Singh N, Gayowski T, Wagener MM, Marino IR (1999) Pulmonary infiltrates in liver transplant recipients in the intensive care unit. Transplantation 67: 1138–1144
Groll AH, Shah PM, Mentzel C et al. (1996) Trends in the postmortem epidemiology of invasive fungal infections at a university hospital. J Infect 33: 23–32
Manfredi R, Salfi N, Alampi G et al. (1998) AIDS-related visceral aspergillosis: an underdiagnosed disease during life? Mycoses 41: 453–460
Hartman BJ, Coleman M, Brause BD, Saletan S (1984) Localized renal aspergillosis with hairy cell leukemia: a review of urinary tract aspergillosis in malignant and nonmalignant conditions. Cancer Invest 2: 199–202
Corr P (2006) Management of severe hemoptysis from pulmonary aspergilloma using endovascular embolization. Cardiovasc Intervent Radiol 29: 807–810
Vahid B, Marik P (2007) Fatal massive hemoptysis in a patient on low-dose oral prednisone: chronic necrotizing pulmonary aspergillosis. Respir Care 52: 56–58
Barnes RA, Denning DW, Evans EG et al. (1996) Fungal infections: a survey of laboratory services for diagnosis and treatment. Commun Dis Rep CDR Rev 6: R69–75
Salerno CT, Ouyang DW, Pederson TS et al. (1998) Surgical therapy for pulmonary aspergillosis in immunocompromised patients. Ann Thorac Surg 65: 1415–1419
Patterson TF, Kirkpatrick WR, White M et al. (2000) Invasive aspergillosis. Disease spectrum, treatment practices, and outcomes. I3 Aspergillus Study Group. Medicine (Baltimore) 79: 250–260
Rubin BG, Sicard GA (2001) The Hemobahn endoprosthesis: a self-expanding polytetrafluoroethylene-covered endoprosthesis for the treatment of peripheral arterial occlusive disease after balloon angioplasty. J Vasc Surg [Suppl 2] 33: 124–128
Deutschmann HA, Schedlbauer P, Berczi V et al. (2001) Placement of Hemobahn stent-grafts in femoropopliteal arteries: early experience and midterm results in 18 patients. J Vasc Interv Radiol 12: 943–950
Castelli P, Caronno R, Piffaretti G et al. (2005) Endovascular repair of traumatic injuries of the subclavian and axillary arteries. Injury 36: 778–782
Danetz JS, Cassano AD, Stoner MC et al. (2005) Feasibility of endovascular repair in penetrating axillosubclavian injuries: a retrospective review. J Vasc Surg 41: 246–254
Kumar V (2004) Endovascular treatment of penetrating injury of axillary vein with Viabahn endoprosthesis. J Vasc Surg 40: 1243–1244
Sanada J, Matsui O, Terayama N et al. (2003) Stent-graft repair of a mycotic left subclavian artery pseudoaneurysm. J Endovasc Ther 10: 66–70
Veraldi GF, Furlan F, Tasselli S et al. (2005) Endovascular repair of intrathoracic left subclavian artery aneurysm with stent grafts: report of a case and review of the literature. Chir Ital 57: 355–359
Saliou C, Badia P, Duteille F et al. (1995) Mycotic aneurysm of the left subclavian artery presented with hemoptysis in an immunosuppressed man: case report and review of literature. J Vasc Surg 21: 697–702
Mori K, Saida Y, Kuramoto K et al. (2000) Transcatheter embolization of mycotic aneurysm of the subclavian artery with metallic coils. J Cardiovasc Surg (Torino) 41: 463–467
Bockler D, Schumacher H, Schwarzbach M et al. (2004) Endoluminal stent-graft repair of aortobronchial fistulas: bridging or definitive long-term solution? J Endovasc Ther 11: 41–48
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Attigah, N., Herpel, E., Kotelis, D. et al. Endovaskuläre Therapie einer aspergilloseinduzierten septischen Arrosionsblutung der A. subclavia. Chirurg 79, 984–987 (2008). https://doi.org/10.1007/s00104-008-1531-9
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DOI: https://doi.org/10.1007/s00104-008-1531-9