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October 3, 1977


JAMA. 1977;238(14):1498. doi:10.1001/jama.1977.03280150068017

To the Editor.—  The necessity of maintaining suspicion for invasive aspergillosis in febrile, neutropenic cancer patients and the need for early aggressive evaluation when pulmonary infiltrates develop have recently been appropriately reemphasized.1 Although rare, one should not, however, overlook the possibility of aspergillosis in non-neoplastic, nonneutropenic settings, as recently occurred in one of our patients.A 55-year-old alcoholic woman was admitted because of acute alcoholic hepatitis. She was afebrile, icteric, and lethargic, and she had hepatomegaly and ascites. Laboratory data included WBC count, 16,000/cu mm; bilirubin level, 20 mg/dl; elevated prothrombin time and hepatic enzymes; and creatinine level, 3.5 mg/dl. Chest film was normal. On the fourth day, the patient became obtunded, oliguric, and febrile to 39 °C. Liver scan showed no focal defects, paracentesis was unremarkable, and sonogram showed a normal biliary tree. The WBC count rose to 24,000/cu mm, and therapy with nafcillin and gentamicin was begun.