A Unique Case of Fungal Endometritis Caused by Aspergillus quadrilineatus in an Immunocompetent Woman and Literature Review

Author: mycolabadmin
2/12/2025
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Summary

A 64-year-old woman experienced persistent vaginal bleeding for three months, which was found to be caused by a rare fungal infection (Aspergillus quadrilineatus) in her uterus. Through tissue examination and molecular testing, doctors identified the fungus and found it was sensitive to common antifungal medications. The patient was successfully treated with antifungal medication combined with surgical cleaning of the uterus, making a complete recovery. This case highlights that fungal infections should be considered when patients have abnormal vaginal bleeding, even if they appear otherwise healthy.

Background

Abnormal uterine bleeding (AUB) is commonly attributed to hormonal disorders, malignancies, or bacterial/viral infections, while fungal infections are often overlooked. Endometrial aspergillosis is an uncommon yet potentially life-threatening condition that presents diagnostic challenges due to its rarity and nonspecific clinical manifestations.

Objective

This case report highlights a rare instance of endometrial aspergillosis caused by Aspergillus quadrilineatus in an immunocompetent woman presenting with persistent vaginal bleeding. The objective is to emphasize the need for increased awareness of fungal infections as a potential cause of AUB and to present the first documented case of isolated endometrial aspergillosis in an immunocompetent patient.

Results

Histopathological examination revealed septate hyphae consistent with fungal infection. Molecular analysis identified the causative agent as A. quadrilineatus with 100% similarity to type strains. The isolate demonstrated susceptibility to voriconazole, itraconazole, amphotericin B, fluconazole, clotrimazole, and 5-flucytosine. Treatment with fluconazole combined with curettage and debridement resulted in complete recovery.

Conclusion

Endometrial aspergillosis caused by A. quadrilineatus can occur in immunocompetent patients and should be considered in cases of AUB with elevated inflammatory markers. Timely diagnosis through endometrial biopsy, combined with prompt intervention using antifungal therapy and surgical debridement, is essential for optimal outcomes. Further research and screening studies are recommended to assess the prevalence of cryptic fungal species in gynecological infections.

Published in:Clinical Case Reports,
Study Type:Case Report,
Source: PMID: 39949584, DOI: 10.1002/ccr3.70146