title: [A case of lung scedosporiosis successfully treated with monitoring of plasma voriconazole concentration level].
abstract: A 71-year-old man was referred because of fever and productive cough. His chest radiograph showed a large cavitary mass with an intracavitary mycetoma-like lesion in the left middle lung field. We undertook bronchoscopy and CT-guided biopsy, and both bronchial lavage fluid culture and CT-guided biopsy culture revealed Scedosporium apiospermum. On a diagnosis of lung scedosporiosis, he was treated with 200 mg/day voriconazole for 2 months, but his symptoms did not improve. Measurement of the plasma voriconazole level showed low plasma concentration levels (peak level: 2.15 microg/ml, trough level: 0.72 microg/ml). We then increased the voriconazole dosage from 200 mg/day to 400 mg/day. After that, his symptoms and chest radiograph findings improved immediately, accompanied by an elevated plasma voriconazole level (peak level: 5.13 microg/ml, trough level: 3.13 microg/ml). We believe that measurement of plasma voriconazole levels is useful to determine its dosage in lung scedosporiosis.
authors.affiliation: Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center.
authors.forename: Ryo
authors.initials: R
authors.lastname: Ogata
authors.forename: Eri
authors.initials: E
authors.lastname: Hagiwara
authors.forename: Jun
authors.initials: J
authors.lastname: Shiihara
authors.forename: Takashi
authors.initials: T
authors.lastname: Ogura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Kamei
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000097:blood*; D006801:Humans; D008172:Lung Diseases, Fungal / Q000188:drug therapy*; D008297:Male; D011743:Pyrimidines / Q000008:administration & dosage* / Q000097:blood*; D021681:Scedosporium; D014230:Triazoles / Q000008:administration & dosage* / Q000097:blood*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole