Liver Disease and Aspergillosis

To the Editor.— In a recent CASE REPORT, D'Silva et al (1982;248:1495) describe disseminated aspergillosis occurring in a patient who was presumably immunocompetent. This patient had a history of excessive alcohol intake, icterus on admission, increased prothrombin time, and elevated liver enzyme levels. Autopsy findings did not reveal features of cirrhosis or alcoholic hepatitis; focal abscesses in the liver containing hyphae of Aspergillus were seen. On the basis of these findings, the authors surmise that the Aspergillus microabscesses probably accounted for the altered liver function study results. Autopsy findings also showed a moderate degree of fatty metamorphosis and areas of centrilobular congestion and necrosis unrelated to the Aspergillus abscesses. In view of these findings, an alternate possibility— that liver injury predisposed to asperillosis—certainly exists. Further support for this possibility is found in the literature.

A review of the literature revealed four cases of disseminated aspergillosis occurring in patients with liver