Unusual forms of subacute invasive pulmonary aspergillosis in patients with solid tumors.
OBJECTIVE
Aspergillus spp. can cause acute invasive disease in severely immunocompromised patients. Nonetheless, there are few reports of solid tumors complicated with subacute invasive pulmonary aspergillosis (subacute IPA).


METHODS
Retrospective observational cohort study, performed in patients with primary lung cancer or secondary lung metastasis complicated with subacute IPA in three referral hospitals.


RESULTS
From 2008 to 2011, 14 episodes of subacute IPA were diagnosed, including 11 (78.6%) probable and 3 proven (21.4%). Nine patients (64.3%) had primary lung cancer. Thirteen patients (92.9%) had more than one local or systemic predisposing factor for subacute IPA. No patient had previous fungal colonization. Aspergillus spp. was isolated in 6 specimens of bronchoalveolar lavage, 6 sputum, 2 biopsies, and 1 percutaneous lung puncture. At the time Aspergillus spp. was isolated, the most common radiologic findings on chest computed tomography (CT) were cavitary masses, and development or expansion of cavitation in existing masses or nodules (10/14, 71.4%). On CT follow-up, most patients (8/12, 66.7%) had new cavity formation or expansion of one or more existing cavities. All patients were treated with azoles and two underwent surgery. Ten (71.4%) patients died after Aspergillus spp. was detected (median time 73 days, IQR 33-243): 2 (20%) deaths were subacute IPA-attributable and 6 (60%) were related.


CONCLUSIONS
Primary lung cancer and secondary lung metastasis seem to be triggering factors for Aspergillus spp. implantation, and predispose to subacute IPA. Once localized in the damaged lung, the mold can grow and cause or expand cavities. In lung cancer patients, Aspergillus spp. detection is associated with a very poor prognosis.
Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain. Electronic address: maddalena.peghin@vhir.org.
M
M
Peghin
Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain.
I
I
Ruiz-Camps
Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain.
C
C
Garcia-Vidal
Department of Infectious Diseases, Hospital Clínic i Provincial de Barcelona, Spain.
C
C
Cervera
Department of Radiology, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain.
J
J
Andreu
Department of Microbiology, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain.
M
M
Martin
Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain.
J
J
Gavaldá
Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain.
C
C
Gudiol
Department of Infectious Diseases, Hospital Clínic i Provincial de Barcelona, Spain.
A
A
Moreno
Department of Oncology, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain.
E
E
Felip
Department of Infectious Diseases, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain.
A
A
Pahissa
D000328:Adult; D000368:Aged; D001230:Aspergillus / Q000302:isolation & purification; D015331:Cohort Studies; D005260:Female; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000473:pathology*; D008175:Lung Neoplasms / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
Aspergillus; Chronic pulmonary aspergillosis; Invasive pulmonary aspergillosis; Lung cancer; Lung metastasis; Solid cancer; Solid tumors; Subacute invasive aspergillosis