Combined intracavitary, systemic antifungal and surgical treatment of Chronic Pulmonary Aspergillosis: experience from an immunocompromised patient

IF 1.1 Q3 MEDICINE, RESEARCH & EXPERIMENTAL

Medical Mycology Case Reports Pub Date : 2025-12-01 Epub Date: 2025-10-13 DOI:10.1016/j.mmcr.2025.100743

Anne Haglund , Jelena Stankovic , Thomas Decker Christensen , Lise Kristensen , Karen Rokkedal Lausch

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Abstract

We present a complex case of Chronic Pulmonary Aspergillosis (CPA) caused by Aspergillus fumigatus in a pre-existing lung cavity in an immunocompromised patient with granulomatosis with polyangiitis. Initial treatment with voriconazole was limited due to adverse effects and emerging azole resistance.Aspergillus Subsequent therapy with intravenous and intracavitary amphotericin B was also poorly tolerated and clinically insufficient. The patient underwent left-sided thoracotomy with decortication. As a novel approach, the patient recieved Post-surgical instillation of liposomal amphotericin B directly into the resected cavity, combined with systemic antifungal therapy. Subsequently the patient recovered with long-term remission. This case highlights the potential role of post-operative intracavitary antifungal instillation as an adjunctive strategy in refractory CPA, particularly when conventional medical therapy fails.2012 Elsevier Ltd. All rights reserved.

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慢性肺曲霉病腔内、全身抗真菌和手术联合治疗：来自免疫功能低下患者的经验

我们提出了一个复杂的慢性肺曲霉病（CPA）引起的烟曲霉在一个预先存在的肺腔在免疫功能低下的病人肉芽肿病多血管炎。由于不良反应和新出现的唑耐药性，伏立康唑的初始治疗受到限制。曲霉：随后静脉注射和腔内注射两性霉素B的治疗耐受性也很差，临床治疗不足。患者行左侧开胸去皮术。作为一种新方法，患者术后将两性霉素B脂质体直接注入切除腔内，并结合全身抗真菌治疗。随后患者恢复，长期缓解。该病例强调了术后腔内抗真菌药作为难治性CPA的辅助策略的潜在作用，特别是当常规药物治疗失败时爱思唯尔有限公司版权所有。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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