title: 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.affiliation: Department of Hematology, Sapporo Hokuyu Hospital, Sapporo 003-0006, Japan. kouichiro.kobayashi@mb3.seikyou.ne.jp
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ogasawara
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kiyama
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Miyazono
authors.forename: Kumiko
authors.initials: K
authors.lastname: Kagawa
authors.forename: Kiyotoshi
authors.initials: K
authors.lastname: Imai
authors.forename: Teiichi
authors.initials: T
authors.lastname: Hirano
authors.forename: Naoki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Mitsune
authors.initials: M
authors.lastname: Tanimoto
authors.forename: Masaharu
authors.initials: M
authors.lastname: Kasai
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis / Q000188:drug therapy*; D015456:Leukemia, Biphenotypic, Acute / Q000150:complications*; D011743:Pyrimidines / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole