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Subacute invasive pulmonary aspergillosis after chemoradiotherapy for lung cancer
Hirofumi Watanabe1, Toshihiro Shirai1, Mika Saigusa1
1Department of Respiratory Medicine Shizuoka General Hospital Shizuoka Japan.
Abstract:
Subacute invasive pulmonary aspergillosis (SIPA), a rapidly progressive fungal infection of less than three months arising from pre-existing lung lesions, generally afflicts moderately immunocompromised patients. We herein report the case of a 69-year-old man who developed SIPA following chemoradiotherapy for lung cancer and treated with antifungal therapy. He presented with fever, and computed tomography revealed a cavity with surrounding consolidation. The cavity itself had been considered as the primary tumour treated by chemoradiotherapy. Bronchoalveolar lavage by bronchoscopy performed at admission identified Aspergillus fumigatus; no other pathogens or malignant cells were observed. Owing to the worsening of symptoms and inflammation despite micafungin administration, the treatment was changed to liposomal amphotericin B with voriconazole, which led to clinical improvement. In addition to cancer recurrence and bacterial infection, fungal infection should also be considered in patients undergoing chemoradiotherapy for lung cancer with deteriorating imaging findings and symptoms. In intractable cases, multiple antifungal drugs are effective.
Insights
Subacute invasive pulmonary aspergillosis (SIPA) is a serious fungal infection. This case highlights its occurrence post-lung cancer chemoradiotherapy and effective treatment with combined antifungal drugs.
Area of Science:
- Pulmonology
- Infectious Diseases
- Oncology
Background:
- Subacute invasive pulmonary aspergillosis (SIPA) typically affects moderately immunocompromised individuals.
- It arises from pre-existing lung lesions and progresses rapidly (less than three months).
Observation:
- A 69-year-old male, undergoing chemoradiotherapy for lung cancer, developed SIPA.
- Initial symptoms included fever; CT scans showed a cavitary lesion with consolidation.
- Bronchoalveolar lavage confirmed *Aspergillus fumigatus* infection.
Findings:
- Initial micafungin treatment was ineffective, leading to worsening symptoms and inflammation.
- Switching to liposomal amphotericin B combined with voriconazole resulted in clinical improvement.
- No other pathogens or malignant cells were detected.
Implications:
- Fungal infections, specifically SIPA, should be considered in lung cancer patients with deteriorating conditions post-chemoradiotherapy.
- Combined antifungal therapy can be effective for intractable cases of SIPA.
- Early diagnosis and appropriate treatment are crucial for managing invasive fungal infections in immunocompromised cancer patients.
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