Invasive pulmonary aspergillosis refractory to amphotericin B in a patient with persisting neutropenia: successful treatment with voriconazole

S.Schoniger, A. Hildebrand, A. Richer, L. Bergmann, W.V. Kern.

Abstract: 

Immunocompromised patients with invasive pulmonary aspergillosis (IPA) have a poor outcome, in particular when there is prolonged severe neutropenia and when effective therapy is not instituted early. We describe the case of a 59-year-old female patient with AML who developed pulmonary infiltrates in the right middle and lower lobe suggestive of IPA. Aspergillus. fumigatus could be isolated repeatedly from sputum. Over a 6-week period of therapy with amphotericin B (AmB; daily dosage 1 mg/kg) there was radiographically documented progression of the pulmonary infiltrates with development of new infiltrates in the left upper lobe after granulocyte recovery. Sputum cultures remained positive for Aspergillus, and the patient developed hemoptoe. Voriconazole (UK-109,496; a new azole) was started as an intravenous infusion (daily dosage: loading with 2X6 mg/kg, then 2X4 mg/kg) and continued orally after 1 week at a daily dose of 2X200 mg. Radiographic and clinical improvement was observed within 2 weeks. The patient remained on voriconazole maintenance treatment for 11 months, during which time chemotherapy-refractory leukemia with persisting neutropenia (
1999

abstract No: 

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Full conference title: 

9th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 9th (1999)