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Invasive pulmonary aspergillosis in a puerperant with drug-induced agranulocytosis
1Department of Medicine, Social Insurance Gunma Chuo General Hospital, Maebashi.
Abstract:
Invasive pulmonary aspergillosis (IPA) is an acute infection of Aspergillus species to the lungs. It generally occurs in immunocompromised hosts, especially with neutropenia. We report a 30-year-old puerperant, who developed IPA from agranulocytosis. She had been treated for threatened labor with ritodrine and cefepime, one of which induced agranulocytosis. After vaginal delivery of twins, pneumonia emerged in the right lower lobe. She was diagnosed to have IPA according to the halo sign on computed tomography (CT) and positive circulating antibody against Aspergillus, and was treated successfully with oral itraconazole followed by surgical resection. It is important to note that IPA might arise in otherwise immunocompetent hosts when neutropenia is long-standing.
Insights
Invasive pulmonary aspergillosis (IPA) can occur in immunocompetent individuals experiencing prolonged neutropenia. This case highlights IPA in a postpartum woman with drug-induced agranulocytosis, successfully treated with antifungals and surgery.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pulmonology
Background:
- Invasive pulmonary aspergillosis (IPA) is a severe lung infection caused by Aspergillus species.
- IPA typically affects immunocompromised individuals, particularly those with neutropenia.
Observation:
- A 30-year-old postpartum woman developed IPA secondary to agranulocytosis.
- The agranulocytosis was potentially induced by medications used for threatened labor (ritodrine and cefepime).
- Pneumonia manifested in the right lower lobe post-delivery of twins.
Findings:
- Diagnosis of IPA was confirmed by characteristic halo sign on CT scan and positive Aspergillus antibodies.
- The patient received successful treatment with oral itraconazole.
- Surgical resection was also performed as part of the treatment regimen.
Implications:
- This case underscores that IPA can emerge in seemingly immunocompetent hosts if neutropenia is persistent.
- Highlights the importance of considering IPA in postpartum patients with unexplained pneumonia and neutropenia.
- Emphasizes the need for vigilant monitoring and prompt treatment of drug-induced agranulocytosis in obstetric patients.