Successful voriconazole treatment of invasive pulmonary aspergillosis in a patient with acute biphenotypic leukemia.

Abstract

A 23-year old woman with acute biphenotypic leukemia (ABL) complained of chest pain with cough, high fever and hemoptysis during induction chemotherapy, although she had been treated with anti-biotics and micafungin. We made a clinical diagnosis of invasive pulmonary aspergillosis (IPA) based on a consolidation in the right upper lung field on a chest radiograph as well as a high level of serum beta-D-glucan (with no evidence of tuberculosis and candidiasis). We changed her treatment from micafungin to voriconazole. Later, we discovered an air-crescent sign by CT scan that supported the diagnosis of IPA. Following voriconazole treatment, clinical symptoms ceased and abnormal chest shadows improved gradually and concurrently with a recovery of neutrophils. IPA must be considered in immunocompromised patients with pulmonary infiltrates who do not respond to broad-spectrum antibiotics. Serological tests and CT findings can aid in early diagnosis of IPA, which, along with treatment for IPA, will improve clinical outcomes.

• Authors: Koichiro Kobayashi, Masahiro Ogasawara, Yoshio Kiyama, Takayoshi Miyazono, Kumiko Kagawa, Kiyotoshi Imai, Teiichi Hirano, Naoki Kobayashi, Mitsune Tanimoto, Masaharu Kasai
• Journal: Acta medica Okayama (Acta Med Okayama) Vol. 63 Issue 4 Pg. 213-6 (Aug 2009) ISSN: 0386-300X [Print] Japan
• PMID: 19727206 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antifungal Agents
• Pyrimidines
• Triazoles
• Voriconazole

Topics

• Adult
• Antifungal Agents (therapeutic use)
• Female
• Humans
• Invasive Pulmonary Aspergillosis (diagnosis, drug therapy)
• Leukemia, Biphenotypic, Acute (complications)
• Pyrimidines (therapeutic use)
• Tomography, X-Ray Computed
• Triazoles (therapeutic use)
• Voriconazole