Severe fungal infections caused by highly invasive fungi such as Aspergillus are not easy to diagnose and often have a poor prognosis. In these cases, the nonspecific symptomsmaymake clinical diagnosis challenging, and consequently, the autopsy and postmortem histological investigations acquire a crucial role.We report the case of a youngman in good health who died of septic shock 3 weeks after having had a tongue piercing. Intravitam investigations did not identify the etiology of the rapidly fatal infectious condition. The autopsy revealed flaccid organs of uniformly diminished consistency with abscesses and granulomatous foci with central necrosis. Histological examination showed the presence of septate mycotic hyphae, with a dichotomous 45-degree bifurcation, typical for Aspergillus, in all the examined organs, including the tongue. The molecular identification confirmed the presence of Aspergillus fumigatus. The observed macroscopic framework and the laboratory findings made it possible to diagnose pseudomembranous invasive tracheobronchial aspergillosis and to attribute the death to fatal invasive disseminated aspergillosis. The consistency and concordance of all the findings in our possession led us to suspect the practice of piercing as the triggering cause of the man's pathology.

Postmortem Diagnosis of Invasive Disseminated Aspergillosis After Tongue Piercing / S. Tambuzzi, G. Gentile, S. Andreola, R. Zoja. - In: THE AMERICAN JOURNAL OF FORENSIC MEDICINE AND PATHOLOGY. - ISSN 0195-7910. - 43:4(2022), pp. 380-384. [10.1097/PAF.0000000000000776]

Postmortem Diagnosis of Invasive Disseminated Aspergillosis After Tongue Piercing

S. Tambuzzi
Primo
;
G. Gentile
Secondo
;
R. Zoja
Ultimo
2022

Abstract

Severe fungal infections caused by highly invasive fungi such as Aspergillus are not easy to diagnose and often have a poor prognosis. In these cases, the nonspecific symptomsmaymake clinical diagnosis challenging, and consequently, the autopsy and postmortem histological investigations acquire a crucial role.We report the case of a youngman in good health who died of septic shock 3 weeks after having had a tongue piercing. Intravitam investigations did not identify the etiology of the rapidly fatal infectious condition. The autopsy revealed flaccid organs of uniformly diminished consistency with abscesses and granulomatous foci with central necrosis. Histological examination showed the presence of septate mycotic hyphae, with a dichotomous 45-degree bifurcation, typical for Aspergillus, in all the examined organs, including the tongue. The molecular identification confirmed the presence of Aspergillus fumigatus. The observed macroscopic framework and the laboratory findings made it possible to diagnose pseudomembranous invasive tracheobronchial aspergillosis and to attribute the death to fatal invasive disseminated aspergillosis. The consistency and concordance of all the findings in our possession led us to suspect the practice of piercing as the triggering cause of the man's pathology.
Aspergillus; tongue piercing; systemic aspergillosis; invasive aspergillosis; pseudomembranous invasive tracheobronchial aspergillosis; autopsy
Settore MED/43 - Medicina Legale
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/931889
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