Case 060: Acute pulmonary aspergillosis in association with chemotherapy for acute myelogenous leuaemia (Paediatric).
Summary:

7-year-old Caucasian male received chemotherapy for treatment of acute myelogenous leukemia.  The patient presented with moderate fever and pain when taking a deep breath, mild tachypnea and two lesions in the right lung consistent with invasive aspergillosis.  A culture from a lung biopsy was positive for Aspergillus flavus.  The patient completed therapy with 42 days micafungin in combination with AmBisome after failing 2 days empirical therapy with combination AmBisome and itraconazole, 1 day 200 mg itraconazole, 5 days combination therapy with 7.8 mg/kg/day AmBisome and 600 mg/day itraconazole and 1 day therapy with 7.8 mg/kg/day AmBisome.

Comments:

Diagnosis:
Acute pulmonary aspergillosis - proven (culture positive lung biopsy). A CT scan showed two lesions in the right lung consistent with invasive aspergillosis and culture from a lung biopsy was positive for Aspergillus flavus.

Response to antifungal therapy:
A complete response was seen, probably augmented by surgery.

Outcome:
At the post treatment visit the patient was not exhibiting any signs of aspergillosis. The patient was probably cured by surgery but antifungal treatment was essential and the patient outcome was excellent.