[Successful treatment by voliconazole for pulmonary and adductor magnus muscle aspergillosis induced by immunosuppressive therapy for hypersensitivity pneumonia].
A 74-year-old woman was treated with steroid and cyclosporine A for hypersensitivity pneumonia. To examine the causes of general fatigue and increased levels of beta-D glucan in serum, she was admitted to our hospital. Chest computed tomography (CT) scan revealed nodular opacity with a well-defined margin in the right S1. 67Ga scintigraphy image showed high uptake in the left thigh and CT showed circularly enhanced lesions in the thigh. An ultrasonography-guided needle aspiration and biopsy of the muscle abscess allowed isolation of Aspergillus fumigatus and evidence of necrotic tissues around the granuloma formation. We therefore diagnosed invasive aspergillosis. Because of the poor response to initial therapy with micafungin and itraconazole for 4 weeks, we treated her with voliconazole (VCZ). Spectacular regression of lung lesions and muscle abscesses was rapidly achieved. Furthermore, the high level of beta-D glucan in serum decreased gradually. This case suggests that administration of VCZ can be recommended for deep seated mycoses.
Ichiyasu
Hidenori
H
Department of Respiratory Medicine, Faculty of Medical and Pharmaceutical Sciences, Kumamoto University.
Yamamura
Akiko
A
Honda
Mitsuko
M
Okamoto
Shinichiro
S
Tsumori
Kaori
K
Okamoto
Tatsuya
T
Sato
Keizo
K
Matsumoto
Mitsuhiro
M
Kohrogi
Hirotsugu
H
D000368:Aged; D000542:Alveolitis, Extrinsic Allergic / Q000150:complications* / Q000188:drug therapy*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D001232:Aspergillus fumigatus; D016572:Cyclosporine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008172:Lung Diseases, Fungal / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D009220:Myositis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D009894:Opportunistic Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D011239:Prednisolone / Q000009:adverse effects* / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use*; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D011743:Pyrimidines; D014230:Triazoles; D016572:Cyclosporine; D011239:Prednisolone; D065819:Voriconazole