Aspergiloză probabil invazivă la un pacient adult după transplantare de celule stem hematopoietice: prezentare de caz

Abstract

Introducere. Infecţiile sunt, deocamdată, cauza principală de deces a pacienţilor adulţi, beneficiari de transplant de celule stem hematopoietice (TCSH). Morbiditatea și mortalitatea de aspergiloză pulmonară invazivă rămâne importantă în rândul recipienţilor TCHS. Un diagnostic de aspergiloză invazivă nu este ușor de confirmat, iar comunicările de caz clinic referitoare la acest tip de infecţie la pacienţii adulţi, beneficiari de TCSH, sunt rareori publicate. Prezentare de caz. Este descris cazul clinic al unui pacient cu limfom Hodgkin, care, probabil, a dezvoltat o formă de aspergiloză pulmonară invazivă după un transplant autolog de celule stem hematopoietice. Infecţia fungică a fost tratată sistemic cu antifungice, dar aceasta s-a dovedit a fi rezistentă la voriconazol, totodată a cedat la administrarea caspofunginei. Discuţii. Acest caz prezintă date clinice interesante și imagini referitoare la diagnosticul aspergilozei pulmonare și indică posibilităţile existente de tratament antifungic. Concluzii. Incidenţa înaltă a aspergilozei invazive la pacienţii beneficiari de TCSH trebuie luată în consideraţie de către medicii care se ocupă de pacienţii transplantaţi. Chiar dacă izolarea prin cultură nu este întotdeauna posibilă, alte semne clinice și teste de laborator (galactomannanul, tomografia computerizată, microscopia sputei) pot fi utile pentru stabilirea diagnosticului de aspergiloză. Voriconazolul rămâne tratamentul de primă linie la pacienţii cu aspergiloză invazivă, cu posibilitatea utilizării echinocandinelor, în cazuri refractare.

Introduction. Infections still stay one the leading causes of death in adult patients undergoing HSCT. Invasive pulmonary aspergillosis remains an important cause of morbidity and mortality in HSCT recipients. Diagnosis of invasive aspergillosis is not easy to be proven, and clinical data regarding this infection in adult HSCT recipients are rarely published. Case presentation. In the present case report, we describe a patient with a Hodgkin’s lymphoma, who developed probable invasive pulmonary aspergillosis after tandem autologous HSCT. The fungal infection was treated by systemic antifungal therapy, but the patient was refractory to voriconazole, showing clinical efficacy on caspofungin. Discussion. This case presents interesting clinical data and images concerning aspergillosis diagnosis and shows the possibilities of antifungal treatment in patients with invasive pulmonary aspergillosis. Conclusion. High incidence of invasive aspergillosis in HSCT patients should be kept in mind of practical doctors dealing with transplant patients. Even though the culture isolation is not always possible, other clinical and laboratory tests (galactomannan, CT-scan, sputum microscopy) may be useful for diagnosis of aspergillosis. Voriconazole remains a treatment of choice for patients with invasive aspergillosis, with a possibility of using echinocandins in refractory cases.

Introduction. Infections still stay one the leading causes of death in adult patients undergoing HSCT. Invasive pulmonary aspergillosis remains an important cause of morbidity and mortality in HSCT recipients. Diagnosis of invasive aspergillosis is not easy to be proven, and clinical data regarding this infection in adult HSCT recipients are rarely published. Case presentation. In the present case report, we describe a patient with a Hodgkin’s lymphoma, who developed probable invasive pulmonary aspergillosis after tandem autologous HSCT. The fungal infection was treated by systemic antifungal therapy, but the patient was refractory to voriconazole, showing clinical efficacy on caspofungin. Discussion. This case presents interesting clinical data and images concerning aspergillosis diagnosis and shows the possibilities of antifungal treatment in patients with invasive pulmonary aspergillosis. Conclusion. High incidence of invasive aspergillosis in HSCT patients should be kept in mind of practical doctors dealing with transplant patients. Even though the culture isolation is not always possible, other clinical and laboratory tests (galactomannan, CT-scan, sputum microscopy) may be useful for diagnosis of aspergillosis. Voriconazole remains a treatment of choice for patients with invasive aspergillosis, with a possibility of using echinocandins in refractory cases.