Date: 26 November 2013
Patient MD with kyphoscoliosis and chronic cavitary pulmonary aspergillosis and an aspergilloma. Patient exhibited azole resistant A. fumigatus.
Further details
Image A. This CT scan cut shown shows a grossly distorted thorax because of the kyphoscoliosis, a nearly normal appearing left lung, her trachea at an odd angle, demonstrating the normal cartilage rings and an aspergilloma in a cavity which has replaced the right upper lobe. The cavity is surrounded by significant pleural thickening and fibrosis.
Image B. The other cut (slightly inferior) shows a complex large cavity and some smaller ones posteriorly, with some material consistent with a fungal ball within the large cavity. There is a separate cavity anteriorly and small air spaces within the extensive pleural thickening. Her trachea is widened. the left lung appears normal.
This patient with repaired juvenile scoliosis first recognised that she had pulmonary aspergillosis when she coughed up large amounts of blood, she was admitted to ICU and underwent bronchial artery embolisation, followed by tranexamic acid orally. A. fumigatus was cultured from sputum. A diagnosis of chronic cavitary pulmonary aspergillosis with an aspergilloma was made. She didn’t improve with itraconazole (no fall in Aspergillus precipitins and continuing symptoms, despite good blood levels) and was treated with voriconazole. She had a good sympomatic response, with marginal improvement in her Aspergillus precipitins titre. Remission continued for over 3 years but then her symptoms of cough and general fatigue returned. Her sputum grew A. fumigatus again, which had MICs to itraconazole (>8 mg/L, resistant), voriconazole (8mg/L, resistant) and posaconazole (2mg/mL, resistant). She is being treated with amphotericin B.
Copyright: n/a
Notes: n/a
Images library
-
Title
Legend
-
After 3 weeks of posaconazole given for chronic pulmonary aspergillosis, patient NC had a remarkable exacerbation of psoriasis. He had had psoriasis for years, with little trouble and almost no treatment. After taking posaconazole 400mg twice daily, he developed psoriatic plaques on his hands for the first time ever. The plaques on his lower legs became confluent. This occurred in association with worsening chest symptoms, notably increased coughing, more breathlessness and increasing oxygen requirement.
Posaconazole was stopped after 3 weeks, and 2 weeks later he was still very symptomatic with his chest. This responded to a 2 week course of corticosteroids, and his psoriasis also improved.
, 
, 
, 
, 
, 
-
Patient PC: An example of localised caspofungin rash and phlebitis related to caspofungin infusion.
, 
-
This 55 year old man with asthma, ABPA, severe bronchiectasis and lung fibrosis was treated with voriconazole, starting in June 2010. He had developed increasing dyspnoea on itraconazole for over 7 years, and his total IgE remained at 1100 KIU/L. He had marked photopsia (visual hallucinations) and facial erythema in the first 3 weeks of therapy. His trough voriconazole concentration was 1.17 mg/L. Over 3 months, he had minor improvement in his breathlessness but continued facial erythema, despite factor 50 sunblock. After 5 months of therapy his facial rash has altered to show acneiform lesions with localised crusting and background severe erythema. His face effectively crusted over, and he stopped therapy.
Over the next 3 weeks his facial appearance slowly improved .
, 
, 
