Reactions 1680, p284 - 2 Dec 2017 Invasive pulmonary Aspergillus fumigatus infection: 3 case reports In a case series, three patients (2 boys and 1 girl) aged 4–8 years were described, who developed invasive pulmonary Aspergillus fumigatus infection (IPAI) following the therapy with prednisone [routes not stated; time to reaction onsets not clearly stated]. Case 1: The 4-year-old boy presented after 3 weeks of dry cough, progressive dyspnoea and fever. He was eventually suspected with the manifestation of mimicking hypersensitivity pneumonitis (HP). He then started receiving therapy with prednisone 1 mg/Kg/day. Consequently, the prednisone dose was tapered. After 3 weeks of the beginning of prednisone taper, he developed fever and cough with purulent sputum. A Chest high-resolution CT (HRCT) scan was performed, which showed consolidation in left upper lobe and cavity in right upper lobe. Sputum culture finding was positive for Aspergillus fumigatus, three times. He was then diagnosed with IPAI due to the prednisone therapy. The boy received voriconazole treatment. After 6 months of the treatment, the lung lesions completely disappeared. Subsequently, he was diagnosed with an underlying chronic granulomatous disease (CGD). It was then revealed that his initial presentation of HP was a manifestation of the CGD. Continuous prophylactic treatment with cotrimoxazole [trimethoprim/ sulfamethoxazole] and itraconazole were administered. No further events recurred in a follow-up period of 4 years. Case 2: The 8-year-old girl presented because of high spiking fever and chills, dry cough, progressive dyspnoea and chest stuffy for 20 days. She was eventually suspected with a manifestation of mimicking HP. She then started receiving therapy with prednisone 1 mg/Kg/day. Consequently, the prednisone dose was tapered. After 3 weeks of the taper, she developed fever, racking cough with purulent sputum and stuffy chest. An HRCT demonstrated multi-nodules, bilaterally distributed along bronchi and part of multinodule fused into pieces more in upper lung. Specific IgG antibody to Aspergillus fumigatus was positive. Both culture of sputum and bronchoalveolar lavage fluid from right middle lobe revealed the manifestation of Aspergillus fumigatus. She was then diagnosed with IPAI due to the prednisone therapy. The girl received treatment with amphotericin B liposomal and voriconazole. Eventually, the nodes disappeared and the pieces shrank. Subsequently, she was diagnosed an underlying CGD. It was then revealed that her initial presentation of HP was a manifestation of the CGD. Continuous prophylactic antibiotic treatment was given. No symptoms recurred. Case 3: The 5-year-old boy presented with with high spiking fever and chills, dry cough and progressive dyspnoea. He was eventually suspected with a manifestation of mimicking HP. He then started receiving therapy with prednisone 1 mg/ Kg/day. Consequently, the prednisone dose was tapered. A slow taper of prednisone was continued after 3 weeks. Specific IgG antibody testing was performed, which was positive to Aspergillus fumigatus. A chest HRCT showed nodular consolidation with halo sign in left upper lobe. He was then diagnosed with IPAI due to the prednisone therapy. The boy received treatment with voriconazole. The halo disappeared and the consolidation shrank. Subsequently, he was diagnosed with an underlying CGD. It was then revealed that his initial presentation of HP was a manifestation of the CGD. Prophylactic antibiotic treatment was continuously administered. No further symptoms occurred. Author comment: "(P)rolonged steroids therapy makes a contribution to occurrence of IPAI by increasing the patient’s susceptibility to infection." Liu H, et al. Mimicking hypersensitivity pneumonitis as an uncommon initial presentation of chronic granulomatous disease in children. Orphanet Journal of Rare Diseases 12: No. 169, 2017. Available from: URL: http://doi.org/10.1186/ s13023-017-0719-9 - China 803284163 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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