A Case of Invasive Pulmonary Aspergillosis during Treatment for Acute Exacerbation of Interstitial Lung Disease

Abstract

Prolonged immunosuppressive therapy is a risk factor for invasive pulmonary aspergillosis. We report a case of a 79-yearold man who underwent immunosuppressive therapy with methylprednisolone and cyclosporine for an acute exacerbation of interstitial lung disease. Ten days after initiation of immunosuppressive therapy, the patient reported night sweats and purulent sputum, and chest computed tomography scan revealed consolidation. He was diagnosed with invasive pulmonary aspergillosis, and required vasopressor support with oxygen therapy. After the administration of voriconazole and the modulation of immunosuppressive therapy, his condition improved. Short-term immunosuppressive therapy can also induce invasive pulmonary aspergillosis.

Efficacy and safety of caspofungin for the treatment of invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

“…7 It is commonly used in clinical settings as an antifungal agent for IPA treatment in patients with impaired renal function, and recent studies have explored its use as a first-line treatment for IPA. 17,18 A prospective study involving 11 countries confirmed the efficacy and tolerability of caspofungin in highrisk populations with IPA, such as those with blood diseases or tumors. 22 Similarly, a German multicenter study determined that a daily caspofungin dose of 200 mg was safe for in vivo use.…”

“…However, microbial cultures require several days or weeks to grow, and invasive sampling for histopathological examinations is not feasible for many patients. 17,18 Our center's medical records (unpublished data) revealed an increase in the admission rates of patients with COPD and IPA. This increase in the admission rate of patients with COPD complicated by IPA necessitates further studies to better understand the factors contributing to these increases in disease prevalence and treatment.…”

“…However, microbial cultures require several days or weeks to grow, and invasive sampling for histopathological examinations is not feasible for many patients. 17 , 18 …”

“…A recent study involving 261 patients with AECOPD identified five patients with IPA (1.91%), with a mortality rate as high as 80% (four of five). 17 , 18 However, it is likely that the incidence of IPA in patients with COPD is underestimated, particularly in high-risk patients during periods of AECOPD.…”