Invasive aspergillosis is a major cause of morbidity and mortality in immunocompromised patients. Many cases of pulmonary, cutaneous, cerebral, and paranasal sinus aspergillosis in immunocompetent patient were defined in literature but disseminated aspergillosis is very rare. Here we present an immunocompetent case with extrapulmonary disseminated aspergillosis due to Aspergillus niger, totally recovered after effective antifungal treatment with voriconazole. 1. Introduction Although hundreds of Aspergillus conidia survive within the inhaled air, no disease development occurs at immune competent individuals [1]. Immunosuppression increases the risk of dissemination of the Aspergillus to all of the solid organs via circulation or by direct tissue invasion [2]. In the experimental models of aspergillosis by hematogenous infection, the microorganisms tend to invade the liver and the spleen especially [3]. However, extra-pulmonary aspergillosis occurs in 25–60% of cases and may involve the central nervous system, liver, skin, and gastrointestinal system [4–6]. In the immunocompetent cases, disseminated aspergillosis is infrequently reported [7]. Herein we would like to present an immunocompetent case with extra-pulmonary disseminated aspergillosis totally recovered after effective antifungal treatment with voriconazole. 2. Case 52-year-old woman was referred to our emergency service with severe abdominal pain. She also complained of progressive jaundice and weight loss for three months. She had no history of immunosuppressive disease or treatment. Physical examination revealed jaundice of the sclera and the entire skin, hepatomegaly, massive and tender splenomegaly, and enlargement of the lymph nodes at occipital, axillary, and the inguinal sites and normal body temperature. Laboratory examination showed that erythrocyte sedimentation rate (ESR) was 120？mm/h, absolute white blood count (WBC) was 15300/mm3, hemoglobin (Hgb) was 10.4？g/dL, and platelet (PLT) count was 443000/μL. Blood smear was performed, and significant eosinophilia (32%) was observed with degranulation and nuclear irregularities. Alanin aminotransferase (ALT) levels were increased to 690？U/L, and the total serum bilirubin was 9.45？mg/dL. Thus abdominal ultrasound imaging was performed confirming the enlargement of the liver and the spleen (186？mm and 200？mm, resp.) and dilatation of both the intra- and extrahepatic biliary tract. As eosinophilia was observed at the peripheral blood smear, bone marrow sampling was performed. Smear of the bone marrow revealed marked eosinophilia (30%) and a
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