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Invasive pulmonary aspergillosis caused by Aspergillus terreus diagnosed using virtual bronchoscopic navigation and endobronchial ultrasonography with guide sheath and successfully treated with liposomal amphotericin B

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Abstract

Invasive aspergillosis is a significant cause of mortality in patients with hematological malignancy. Early diagnosis of invasive pulmonary aspergillosis (IPA) by bronchoscopy is recommended but is often difficult to perform because of small lesion size and bleeding risk due to thrombocytopenia. A 71-year-old woman had received initial induction therapy for acute myeloid leukemia. On day 22 of chemotherapy, she had a high fever, and the chest computed tomography scan revealed a 20-mm-sized nodule with a halo sign. Bronchoscopy assisted by virtual bronchoscopic navigation (VBN) and endobronchial ultrasonography with a guide sheath (EBUS-GS) was performed, and Aspergillus terreus was identified from the culture of obtained specimens. A. terreus is often resistant to amphotericin B; thus, voriconazole is usually recommended for treatment. However, the obtained A. terreus isolate showed minimal inhibitory concentrations of 2 µg/mL for voriconazole and 0.5 µg/mL for amphotericin B. Therefore, the patient was successfully treated with liposomal amphotericin B. For patients suspected of having IPA, early diagnosis and drug susceptibility testing are very important. This case suggests that bronchoscopy using VBN and EBUS-GS is helpful for accurate diagnosis and successful treatment even if the lesion is small and the patient has a bleeding risk.

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Authors and Affiliations

  1. Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Naoko Yoshii, Kanako Sato, Toshiyuki Nakai, Kazuhiro Yamada, Tetsuya Watanabe, Kazuhisa Asai & Tomoya Kawaguchi

  2. Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Osaka, Japan

    Naoko Yoshii, Koichi Yamada, Waki Imoto, Kazushi Yamairi, Wataru Shibata, Hiroki Namikawa & Hiroshi Kakeya

  3. Department of Infection Control and Prevention, Osaka City University Hospital, Osaka, Japan

    Koichi Yamada, Makoto Niki, Wataru Shibata & Hiroshi Kakeya

  4. Department of Medical Education and General Practice, Graduate School of Medicine, Osaka City University, Osaka, Japan

    Hiroki Namikawa

  5. Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan

    Kazuki Sakatoku

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  1. Naoko Yoshii
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  2. Koichi Yamada
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  3. Makoto Niki
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  9. Kanako Sato
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  13. Kazuhisa Asai
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  14. Hiroshi Kakeya
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  15. Tomoya Kawaguchi
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Contributions

Attending physician: KS, Microbiological examination: MN, Writing—original draft preparation: NY; Writing—review and editing: All authors.

Corresponding author

Correspondence to Naoko Yoshii.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from the patient for publication of this case report and accompanying images.

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Yoshii, N., Yamada, K., Niki, M. et al. Invasive pulmonary aspergillosis caused by Aspergillus terreus diagnosed using virtual bronchoscopic navigation and endobronchial ultrasonography with guide sheath and successfully treated with liposomal amphotericin B. Infection 49, 1049–1054 (2021). https://doi.org/10.1007/s15010-020-01545-x

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  • DOI: https://doi.org/10.1007/s15010-020-01545-x

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