간이식후 전신성 칸디다증과 아스페르길루스증 - 1부검 보고 -
Disseminated Systemic Candidiasis and Aspergillosis in a Liver Transplant Patient: An Autopsy Report
김나래, 김대수, 고영혜, 김성주,
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김나래 ( Kim Na-Rae )
성균관대학교 의과대학 삼성서울병원 진단병리과
김대수 ( Kim Dae-Su )
성균관대학교 의과대학 삼성서울병원 진단병리과
고영혜 ( Ko Young-Hyeh )
성균관대학교 의과대학 삼성서울병원 진단병리과
김성주 ( Kim Sung-Joo )
성균관대학교 의과대학 삼성서울병원 외과학교실
KMID : 0357920020360050348
Abstract
Postoperative complications of liver transplantation include rejection, infection, hepatic vascular thrombus, and primary graft failure, etc. Among them, fungal infection shows nonspecific clinical symptoms and overlapping laboratory findings with variable etiologies causing post-transplant hepatic dysfunction. Therefore, early diagnosis of fungal infection is not easy. Here, we report an autopsy case of disseminated candidiasis and aspergillosis in a liver transplant patient. The case was at first misinterpreted as acute cellular rejection on biopsy because the histology of predominantly cellular infiltration, ductulitis and endothelialitis were similar to those of acute cellular rejection. On autopsy, the liver, lung and kidney showed multifocal hemorrhagic infarcts due to intra-arterial fungal emboli, which were composed mostly of candida species and a minor fraction of aspergillus. Fungal thrombi invading portal vein, intrahepatic arterioles with subsequent coagulation necrosis, venulitis and ductulitis were ascribed to the misdiagnosis on biopsies. It is unusual that systemic candidiasis, unlike aspergillosis, involves large arteries.
키워드
Liver Transplantation;Candidiasis;Aspergillosis;Graft Rejection
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