Aspergillosis complicating a microwave ablation cavity.
We present a case of a patient who following chemotherapy developed semi-invasive pulmonary aspergillosis and an aspergilloma in a lung cavity previously formed by microwave ablation (MWA). A 55-year-old woman presented with cough and shortness of breath after finishing three cycles of chemotherapy for a metastatic nerve sheath tumour. She had been treated by MWA for pulmonary metastases 2 years previously which resulted in a residual right apical lung cavity. Postchemotherapy imaging showed that this cavity had enlarged, developed a thicker wall and contained lobulated soft tissue with a crescent sign on coronal reformats. In addition, the patient's Aspergillus-specific IgG was markedly raised. Treatment with itraconazole improved the symptoms and reduced the cavity size and wall thickness. This case shows that persisting lung cavities after MWA are a potential site for semi-invasive aspergillosis and has implications for the timing of chemotherapy in patient with metastatic lung disease.
Interventional Oncology Service, University College London Hospital, London, UK.
Saurabh
http://orcid.org/0000-0002-8730-524X
S
Singh
Interventional Oncology Service, University College London Hospital, London, UK.
Steven
S
Bandula
Respiratory Division of Medicine, University College London, London, UK.
Jeremy
J
Brown
The London Sarcoma Service, University College London Hospital, London, UK.
Jeremy
J
Whelan
Interventional Oncology Service, University College London Hospital, London, UK.
Rowland
R
Illing
D055011:Ablation Techniques / Q000009:adverse effects*; D000935:Antifungal Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008168:Lung / Q000382:microbiology; D008175:Lung Neoplasms / Q000532:radiotherapy / Q000556:secondary; D008872:Microwaves; D008875:Middle Aged; D018317:Nerve Sheath Neoplasms / Q000188:drug therapy; D055732:Pulmonary Aspergillosis / Q000188:drug therapy / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects* / Q000379:methods
D000935:Antifungal Agents; D017964:Itraconazole