Case 057: Acute pulmonary aspergillosis in infant with myelodysplasia receiving chemotherapy
Summary:

1-year-old Caucasian female receiving chemotherapy for treatment of myelodysplastic syndrome presented with mild decreased appetite and loose stool. Cytology of a pulmonary fine needle aspirate showed fungal hyphae consistent with Aspergillus.  The patient completed therapy with 28 days micafungin after not responding to 18 days 4.4 mg/kg/day AmBisome therapy.

Comments:

Diagnosis:
Acute invasive pulmonary aspergillosis.

Response to antifungal therapy:
This child had a good response to the addition of micafungin 1.5mg/Kg/d over 4 weeks, in combination with Ambisome, having not improved with Ambisome at the same dose over the prior 2.5 weeks. The lesion fibrosed during the subsequent treatment regime with itraconazole and AmBisome, leaving a streaky shadow, consistent with healed invasive aspergillosis.

Outcome:
A partial response to micafungin was observed and further treatment with itraconazole in combination with AmBisome reulted in healing of lesions associated with invasive aspergillosis.