Hepatic and subcutaneous abscesses due to aspergillosis. Initial diagnosis of a case by intraoperative fine needle aspiration cytology

Laparotomy of a 64-year-old woman with bleeding caused by a perforated anastomotic peptic gastric ulcer disclosed a mycotic abscess in the lower surface of the left hepatic lobe covering the ulcer. Fine needle aspiration (FNA) of the abscess produced a clear milky liquid that was positive for Aspergillus fungi by cytology and subsequent microbiologic and cultural studies. Postoperative diffusion of the aspergillosis into the subcutaneous tissue was similarly confirmed by cytology and Sabouraud solid medium culture. This appears to be the first case of disseminated aspergillosis diagnosed by intraoperative FNA cytology; it confirms that FNA cytology is a rapid, sensitive and important tool for the diagnosis of mycotic infections.