Guo T, Wang X, Wang SY, Lin TF. Isolated colonic aspergillosis in an immunocompetent individual diagnosed by metagenomic next-generation sequencing: A case report. World J Gastroenterol 2026; 32(13): 114563 [DOI: 10.3748/wjg.v32.i13.114563]
Corresponding Author of This Article
Tao-Fa Lin, MM, Academic Fellow, Attending Physician, Department of Infections, 900th Hospital of PLA Joint Logistic Support Force, No. 156 West Second Ring North Road, Gulou District, Fuzhou 350025, Fujian Province, China. ltfa2016@qq.com
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Gastroenterology & Hepatology
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Case Report
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Apr 7, 2026 (publication date) through Mar 27, 2026
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World Journal of Gastroenterology
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1007-9327
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Guo T, Wang X, Wang SY, Lin TF. Isolated colonic aspergillosis in an immunocompetent individual diagnosed by metagenomic next-generation sequencing: A case report. World J Gastroenterol 2026; 32(13): 114563 [DOI: 10.3748/wjg.v32.i13.114563]
World J Gastroenterol. Apr 7, 2026; 32(13): 114563 Published online Apr 7, 2026. doi: 10.3748/wjg.v32.i13.114563
Isolated colonic aspergillosis in an immunocompetent individual diagnosed by metagenomic next-generation sequencing: A case report
Ting Guo, Xian Wang, Shao-Yang Wang, Tao-Fa Lin
Ting Guo, Department of Infections, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou 350025, Fujian Province, China
Xian Wang, Shao-Yang Wang, Tao-Fa Lin, Department of Infections, 900th Hospital of PLA Joint Logistic Support Force, Fuzhou 350025, Fujian Province, China
Author contributions: Guo T designed the report; Lin TF and Wang X collected the patient’s clinical data; Guo T, Wang X, and Wang SY analyzed the data and wrote the manuscript; Lin TF reviewed the work and is the corresponding author of this manuscript; and all authors reviewed and approved the final manuscript.
Supported by the Subproject of National Key Research and Development Program of China, No. 2022YFC2305000.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Corresponding author: Tao-Fa Lin, MM, Academic Fellow, Attending Physician, Department of Infections, 900th Hospital of PLA Joint Logistic Support Force, No. 156 West Second Ring North Road, Gulou District, Fuzhou 350025, Fujian Province, China. ltfa2016@qq.com
Received: September 24, 2025 Revised: November 14, 2025 Accepted: February 2, 2026 Published online: April 7, 2026 Processing time: 184 Days and 18.8 Hours
Abstract
BACKGROUND
Invasive aspergillosis (IA) is typically considered an opportunistic pulmonary infection in immunocompromised hosts. Its occurrence in immunocompetent individuals, particularly as an isolated infection of the lower gastrointestinal tract, is exceedingly rare. Such cases are frequently misdiagnosed as inflammatory bowel disease or other infectious enteritides, leading to delays in appropriate treatment. To the best of our knowledge, only 2 cases of primary (or isolated) intestinal aspergillosis (PA) have been reported in the English literature.
CASE SUMMARY
We report a case of a 48-year-old male, who previously underwent thyroidectomy for thyroid cancer but lacked the typical risk factors for IA. He presented to our hospital with refractory diarrhea accompanied by a 6 kg weight loss. Initial colonoscopy revealed erosions in the transverse colon. Routine blood tests and standard microbiological investigations (including bacterial cultures, parasite screening, and tuberculosis testing) were negative. Empirical antibiotic therapy and conventional symptomatic management proved ineffective. Ultimately, metagenomic next-generation sequencing (mNGS) of colonic biopsy tissue detected a relatively high abundance of Aspergillus fumigatus. Diarrhea ceased completely within 48 hours of initiating oral voriconazole therapy. A total treatment course of 12 days was administered, and the patient remained symptom-free during a 2-month follow-up period without recurrence.
CONCLUSION
For immunocompetent patients with refractory diarrhea, PA should be considered and mNGS-guided antifungals should be initiated.
Core Tip: This case report describes an unusual presentation of refractory diarrhea in a patient who was immunocompetent and had none of the usual risk factors. Despite comprehensive evaluations including endoscopy and histopathology, the etiology remained undetermined. Metagenomic next-generation sequencing (mNGS) identified Aspergillus fumigatus, guiding successful targeted treatment. This highlights the necessity of considering primary intestinal aspergillosis (PA) in certain patients and demonstrates the diagnostic value of mNGS for rare fungal enteritis. Although publication bias may exist, accumulating case reports support considering PA when diagnosing unexplained diarrhea. Furthermore, the use of mNGS is justified when conventional diagnostic methods are inconclusive.
