title: A 76-year-old man with a right lung adenocarcinoma and invasive Aspergillosis.
abstract: A 76-year-old male with adenocarcinoma on the right lung underwent five cycles of chemotherapy with pemetrexed disodium, cisplatin, and dexamethasone. Imaging studies of control showed a node in a cavitary lesion on the left lung, and the main hypothesis was Aspergillus infection. PCR was utilized and contributed to establish the early diagnosis in this patient with invasive aspergillosis. Furthermore, the species Aspergillus fumigatus was characterized by its growing at 50 °C but not at 10 °C, typical culture features, and presence of subclavate vesicles. Diagnosis criteria for Aspergillus pulmonary infection include characteristic clinical and imaging findings, elevated C-reactive protein and erythrocyte sedimentation rate, positive specific serological test, and isolation of Aspergillus from bronchoalveolar cultures. Molecular methods, as PCR, have been useful to complement the conventional microbiological investigations in immunocompromised people with invasive fungal infections. The patient was successfully treated with a schedule of voriconazole 4 mg/kg intravenous infusion every 12 h for 21 days and then switched to oral administration of 200 mg twice a day. He has been comfortable, maintaining normal vital signs, and the results of the periodical microbiologic tests of control are negative. Pathogenesis of invasive aspergillosis in patients with lung cancer is not completely understood. Case studies may contribute to a better knowledge about Aspergillus infection in this setting.
authors.affiliation: Medical Course of Catholic University, Brasília, DF, Brazil. vitorinomodesto@gmail.com
authors.forename: Vitorino Modesto
authors.initials: VM
authors.lastname: Dos Santos
authors.forename: Marcos Correa
authors.initials: MC
authors.lastname: da Trindade
authors.forename: Diogo Wagner da Silva
authors.initials: DW
authors.lastname: de Souza
authors.forename: Ana Isabel Costa
authors.initials: AI
authors.lastname: de Menezes
authors.forename: Patricia Midori
authors.initials: PM
authors.lastname: Oguma
authors.forename: Afonso Lucas Oliveira
authors.initials: AL
authors.lastname: Nascimento
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D000077192:Adenocarcinoma of Lung; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001232:Aspergillus fumigatus / Q000145:classification / Q000235:genetics / Q000254:growth & development / Q000302:isolation & purification*; D006651:Histocytochemistry; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology; D008168:Lung / Q000382:microbiology / Q000473:pathology; D008175:Lung Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008853:Microscopy; D025202:Molecular Diagnostic Techniques; D016133:Polymerase Chain Reaction; D049268:Positron-Emission Tomography; D011743:Pyrimidines / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole