A 76-year-old Man with a Right Lung Adenocarcinoma and Invasive Aspergillosis

Abstract

A 76-year-old male with adenocarcinoma on the right lung underwent five cycles of chemotherapy with pemetrexed disodium, cisplatin, and dexamethasone. Imaging studies of control showed a node in a cavitary lesion on the left lung, and the main hypothesis was Aspergillus infection. PCR was utilized and contributed to establish the early diagnosis in this patient with invasive aspergillosis. Furthermore, the species Aspergillus fumigatus was characterized by its growing at 50 °C but not at 10 °C, typical culture features, and presence of subclavate vesicles. Diagnosis criteria for Aspergillus pulmonary infection include characteristic clinical and imaging findings, elevated C-reactive protein and erythrocyte sedimentation rate, positive specific serological test, and isolation of Aspergillus from bronchoalveolar cultures. Molecular methods, as PCR, have been useful to complement the conventional microbiological investigations in immunocompromised people with invasive fungal infections. The patient was successfully treated with a schedule of voriconazole 4 mg/kg intravenous infusion every 12 h for 21 days and then switched to oral administration of 200 mg twice a day. He has been comfortable, maintaining normal vital signs, and the results of the periodical microbiologic tests of control are negative. Pathogenesis of invasive aspergillosis in patients with lung cancer is not completely understood. Case studies may contribute to a better knowledge about Aspergillus infection in this setting.

Pneumonia in a patient with lung cancer

“…Although the initial evaluation did not reveal the exact origin of systemic inflammatory response and respective causal agent, the positive galactomannan test was strongly indicative of Infection by Aspergillus [1,3,4]. Biopsy samples of lung tissue were sent to histopathology and bacteriologic studies, and the diagnosis of IPA was finally characterized based on the classical criteria [ [1][2][3][4][5]. In accordance with a previous successful outcome, the authors utilized monotherapy with voriconazole to treat the present case of IPA affecting a patient with lung cancer [3].…”

“…A 64-year-old male with antecedent of right lung adenocarcinoma submitted to chemotherapy and corticosteroids had prolonged febrile neutropenia associated with clinical and radiographic features of pneumonia. Although the initial evaluation did not reveal the exact origin of systemic inflammatory response and respective causal agent, the positive galactomannan test was strongly indicative of Infection by Aspergillus [1,3,4]. Biopsy samples of lung tissue were sent to histopathology and bacteriologic studies, and the diagnosis of IPA was finally characterized based on the classical criteria [ [1][2][3][4][5].…”

“…Prolonged neutropenia is defined when this change persists for more than 10 days [1]. Invasive Pulmonary Aspergillosis (IPA) usually affects individuals with prolonged neutropenia, which has been considered the major risk factor for this severe infection [1][2][3][4][5]. Corticosteroid therapy plays an additional role in severity and duration of neutropenia [1].…”

“…Corticosteroid therapy plays an additional role in severity and duration of neutropenia [1]. The clinical presentations of this mycosis are allergic bronchopulmonary aspergillosis, chronic necrotizing pulmonary aspergillosis, aspergilloma, and invasive aspergillosis [3]. Indicative data of pulmonary aspergillosis are clinical and imaging findings, elevated C-reactive protein and erythrocyte sedimentation rate, and positive galactomannan test [3]; diagnosis of IPA depends on histopathological findings of hyphae and positive culture [4,5].…”

“…The clinical presentations of this mycosis are allergic bronchopulmonary aspergillosis, chronic necrotizing pulmonary aspergillosis, aspergilloma, and invasive aspergillosis [3]. Indicative data of pulmonary aspergillosis are clinical and imaging findings, elevated C-reactive protein and erythrocyte sedimentation rate, and positive galactomannan test [3]; diagnosis of IPA depends on histopathological findings of hyphae and positive culture [4,5]. We report a case of IPA in a male patient previously treated for lung adenocarcinoma, who had lung infection by A. fumigatus related to neutropenia and corticoid therapy.…”