[Pulmonary aspergillosis in a child with chronic granulomatous disease]

Area of Science:

• Immunology
• Infectious Diseases
• Pediatrics

Background:

• Chronic granulomatous disease (CGD) predisposes individuals to severe bacterial and fungal infections.
• Primary prophylaxis is crucial for preventing opportunistic infections like Pneumocystis and Aspergillus in CGD patients.
• Early and aggressive management is key to improving outcomes in CGD-related infections.

Observation:

• A 12-year-old boy with CGD presented with refractory pleuro-pneumonia at age 10, despite long-term prophylaxis.
• Aspergillus was identified as the causative agent through clinical, radiological, and serological evidence.
• The patient developed dorsal spondylodiscitis, with suspected vertebral aspergillosis or Pott's disease.

Findings:

• Amphotericin B treatment led to a positive clinical and radiological response for the pleuro-pulmonary infection.
• A combination therapy including antituberculous agents, antifungals, interferon (IFN), granulocyte transfusions, and granulocyte-macrophage colony-stimulating factor (GM-CSF) achieved clinical improvement and radiological stabilization for spondylodiscitis.
• Vertebral biopsy was inconclusive, necessitating a comprehensive treatment approach.

Implications:

• This case underscores the importance of considering invasive fungal infections, particularly Aspergillus, in CGD patients with refractory pneumonia.
• The successful management of complex vertebral aspergillosis highlights the potential benefit of multimodal adjuvant therapies in immunocompromised patients.
• Further research into optimal prophylaxis and treatment strategies for invasive fungal infections in CGD is warranted.