Successful voriconazole treatment of invasive pulmonary aspergillosis in a patient with acute biphenotypic leukemia.
Author(s): Kobayashi K, Ogasawara M, Kiyama Y, Miyazono T, Kagawa K, Imai K, Hirano T, Kobayashi N, Tanimoto M, Kasai M
Affiliation(s): Department of Hematology, Sapporo Hokuyu Hospital, Sapporo 003-0006, Japan. kouichiro.kobayashi@mb3.seikyou.ne.jp
Publication date & source: 2009-08, Acta Med Okayama., 63(4):213-6.
Publication type: Case Reports
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.
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