Invasive
aspergillosis is an important cause of morbidity and mortality in immunocompromised patients. Among primary immunodefiencies,
chronic granulomatous disease (CGD) has the highest prevalence of invasive
fungal diseases.
Voriconazole is recommended for the primary treatment of invasive
aspergillosis in most patients. In patients whose
aspergillosis is refractory to
voriconazole, therapeutic options include changing class of antifungal, for example using an
amphotericin B formulation, an
echinocandin, combination
therapy, or further use of
azoles.
Posaconazole is a
triazole derivative which is effective in
Aspergillosis prophylaxis and treatment. Rarely, surgical
therapy may be needed in some patients. Lesions those are contiguous with the great vessels or the pericardium, single cavitary lesion that cause
hemoptysis, lesions invading the chest wall,
aspergillosis that involves the skin and the bone are the indications for surgical
therapy.Chronic granulomatous disease (CGD) is an inherited immundeficiency caused by defects in the phagocyte
nicotinamide adenine dinucleotidephosphate (
NADPH) oxidase complex which is mainstay of killing microorganisms. CGD is characterized by recurrent life-threatening bacterial and
fungal infections and by abnormally exuberant inflammatory responses leading to
granuloma formation, such as
granulomatous enteritis, genitourinary obstruction, and
wound dehiscence. The diagnosis is made by neutrophil function testing and the genotyping.Herein, we present a case with CGD who had
invasive pulmonary aspergillosis refractory to
voriconazole and liposomal amphotericine B combination
therapy that was controlled with
posaconazole treatment and pulmonary surgery.