An Unusual Case of Pulmonary Invasive Aspergillosis and Aspergilloma Cured with Voriconazole in a Patient with Cystic Fibrosis

Abstract

The development of pulmonary aspergilloma and invasive aspergillosis is a rare complication of cystic fibrosis. We describe a 29-year-old patient with cystic fibrosis who had invasive pulmonary aspergillosis that was not cured by amphotericin B, liposomal amphotericin B, or itraconazole. This patient was subsequently successfully treated and cured with the novel antifungal agent voriconazole.

Lack of Efficacy of Voriconazole Therapy in 2 Patients with Pulmonary Fungus Balls

“…In contrast to the patient described by Chow et al [6], neither of our patients cleared the pulmonary fungus ball after several months of therapy with voriconazole, despite the in vitro susceptibility of the fungal isolates. We administered voriconazole at the standard dosage of 200 mg po b.i.d.…”

“…Voriconazole showed a remarkable efficacy in persons with invasive aspergillosis in a clinical trial [5], but there are no data yet on its efficacy in patients with aspergilloma. In a recent report, Chow et al [6] described a patient with pulmonary aspergilloma that was cured with voriconazole. The favorable outcome in this case report led us to use the drug in 2 patients with pulmonary fungus balls.…”

“…It is well known that CD4 + T lymphocytes present different subsets with different competencies during an immune response [5]. In particular, 2 distinct subsets have been identified: CD4 + Th1 lymphocytes, which produce IFN-g and IL-2 and are involved in cell-mediated immunity, and CD4 + Th2 lymphocytes, which secrete IL-4 and IL-10 and are implicated in humoral immunity through B cell stimulation [5][6][7]. Furthermore, it has been shown recently that the presence of cryoglobulins in HIV-HCV-coinfected patients was associated with a lower CD4 + cell count [3].…”

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

“…Voriconazole Efficacy of voriconazole (VRC) against IA was first demonstrated in some reports, including after the use of AmB-d, lipid formulation of amphotericin B deoxycholate, or itraconazole [32,[147][148][149]. These results were confirmed in a recent study that reported the superiority of VRC (two i.v.…”

“…Recently, some reports have suggested that high doses of inhaled corticosteroids may also be a risk factor for IPA [31][32][33]. Explanations as to how steroids may promote IPA are discussed later (see Pathophysiology section).…”