Disseminated Aspergillosis Complicating Hepatic Failure

Disseminated aspergillosis is not generally known as a complication of hepatic failure. Three patients with subacute hepatic necrosis died of clinically unrecognized disseminated aspergillosis. All of the patients had pulmonary aspergillosis and Aspergillus infections of the CNS. Focal neurologic deficits were clinically misconstrued as intracerebral hemorrhages caused by the coagulopathy of liver failure. Signs of invasive pulmonary aspergillosis were ascribed to refractory bacterial pneumonia. Each patient had a hospital course of longer than three weeks and each received treatment with corticosteroids and intravenous antibiotics. Invasive aspergillosis should be considered as a cause of refractory pneumonia and of new focal neurologic deficits in patients with hepatic failure.