Chest Infections |

Resistant Bronchopulmonary Aspergillus Infection Presenting as a Community Acquired Atypical Pneumonia FREE TO VIEW

Kevin Charles, MD; Sandhya Sharma, MBBS; Shyamala Arani, MBBS; Jaime Molina Marinez, MD; James Walsh, MD
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Guthrie Clinic/ Robert Packer Hospital, Sayre, PA

Chest. 2015;148(4_MeetingAbstracts):103A. doi:10.1378/chest.2280708
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SESSION TITLE: Chest Infections II: Student Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: The recent clinical emergence of azole resistant Aspergillus fumigatus is prompting research directed at developing more aggressive treatment options for these resistant strains.

CASE PRESENTATION: We present a case of a 64 year old male with past medical history of coronary artery disease and diabetes mellitus, admitted with complaints of fatigue, dyspnea, and productive cough, after two weeks of progressively worsening symptoms. Occupational history was positive for mold exposure related to work in contracting. Patient failed outpatient therapy with ciprofloxacin and prednisone taper and was in acute distress on presentation. He was febrile and hypotensive, requiring ICU admission. Initial chest radiograph revealed bibaslar pathcy opacities. Inital computed tomography of the chest showed characterstic tree and bud opacification. Sputum culture grew Aspergillus and treatment with voriconazole was initiated. His condition continued to deteriorate. Repeat chest computed tomography showed significant progression of inflammatory lung disease with peribronchial areas of consolidation and cavitation. Patient underwent transbronchial biopsy which revealed Aspergillus in respiratory mucosa and lung tissue. He was placed on Amphotericin B and Caspofungin due to the fact that this strain of Aspergilus was thought to be highly resistant. Broncheoalveolar lavage samples that grew Aspergillus fumigatus have been sent to New York state lab for sensitivites and results are pending at this time. However, on current regimen, patient is showing tremendous improvement. While resistant aspergillous infection is rare in the United States, deteriorating clinical presentation and worsening computed tomography findings prompted aggressive medical treatment, which proved to be quite benficial.

DISCUSSION: This case highlights the rare occurence of resistant, locally invasive bronhcopulmonary aspergillosis in a non-immunosupressed patient. The transbronchial biopsy results strongly support this diagnosis and the senstivity results will serve to illustrate the pathogen's resistant nature. There have not been many cases of resistant bronchopulmonary aspergillosis in the United States, and the patient's failure on voriconzaole and improvement on amphotericn B and caspofungin highlights the importance of aggressive mangement in these cases.

CONCLUSIONS: Although rare, this case highlights the importance of aggressive management of patients with resistant locally invasive bronchopulmonary aspergillosis. These patients also require complete immunolgical work-up to investigate for possible manifestations of immunosupressive conditions.

Reference #1: Mayr A, Lass-Florl C., Epidemiology and antifungal resistance in invasvie Aspergillosis according to primary disease: review of the literature. Eur J Med Res. 2011 Apr 28;16(4):153-7

Reference #2: Wei X, Zhang Y, Lu L., The molecular mechanism of azole resitance in Aspergillus fumigatus: from bedside to bench and back J Microbiol. 2015 Feb;53(2):91-9

DISCLOSURE: The following authors have nothing to disclose: Kevin Charles, Sandhya Sharma, Shyamala Arani, Jaime Molina Marinez, James Walsh

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