
==== Front
Gastro Hep Adv
Gastro Hep Adv
Gastro Hep Advances
2772-5723
Elsevier

S2772-5723(24)00086-4
10.1016/j.gastha.2024.06.006
Images of the Month
A Healthy Man With Gastric Aspergillosis
Clark Ellen clarelle@ohsu.edu
1∗
VanSandt Mandy 2
Yoo Eric R. 3
1 Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon
2 Department of Pathology & Laboratory Medicine, Oregon Health and Science University, Portland, Oregon
3 Department of Gastroenterology, Palo Alto Foundation Medical Group, Santa Cruz, California
∗ Correspondence: Address correspondence to: Ellen Clark, MD, 3181 SW Sam Jackson Park Rd, Portland, Oregon 97239. clarelle@ohsu.edu
22 6 2024
2024
22 6 2024
3 7 883884
14 5 2024
5 6 2024
© 2024 The Authors
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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pmcWe present a 28-year-old healthy man who recently immigrated from Mexico and presented with acute arthralgias and confusion. He rapidly developed septic shock with broad source workup only notable for campylobacter enterocolitis. We were then consulted for active hematemesis. The upper endoscopy revealed fresh blood throughout the stomach and a large area of oozing, full-thickness, severe gastric ulcers on the lesser curvature of the stomach, extending into the antrum (Figure A). The mucosa appeared necrotic and perforation could not be ruled out (Figure B). Hemoclip placement was unsuccessful in the absence of healthy mucosa and multiple rounds of hemostatic spray were deployed but the oozing persisted. The surgical team emergently performed a partial distal gastrectomy. Surgical pathology hematoxylin and eosin stain revealed extensive gastric ulcerations and necrosis (Figure C). Grocott's methenamine silver stain illustrated innumerable fungal forms, which speciated Aspergillus Fumigatus (Figure D). This later disseminated to his lungs. He responded well to treatment and discharged home. His immunodeficiency workup was negative, and the infectious disease team felt the only plausible explanation for gastric involved disseminated aspergillosis in this otherwise healthy patient could be a large ingestion of aspergillus spores and aflatoxin. Endoscopy was paramount to this unusual diagnosis and targeting intervention.

Conflicts of Interest: The authors disclose no conflicts.

Funding: The authors report no funding.

Ethical Statement: Informed consent was obtained from the patient for the publication of this information and imaging with the assistance of a Spanish speaking interpreter.

Reporting Guidelines: There were no specific reporting guidelines for our article type, though the case report CARE guidelines were reviewed.
