| Autor: |
Wang, Lili, Wang, Fengling, Mao, Enqiang, Chen, Erzhen, Chen, Dayu, Wang, Linyu, Qiu, Yusi, Bian, Xiaolan, Li, Yan, He, Juan |
| Zdroj: |
View; June 2024, Vol. 5 Issue: 3 |
| Abstrakt: |
Pneumocystis jiroveciipneumonia and invasive pulmonary aspergillosis are both life‐threatening opportunistic fungal infections. There are only few reports of coinfection by these two fungi in the literature, and Aspergillus fumigatusis the predominant Aspergillusspecies in the coinfection. We report here the first case of coinfection by Aspergillus terreusand P. jiroveciipneumonia and caspofungin can be an appropriate choice for salvage treatment of the coinfection. A 51‐year‐old man with a history of immune thrombocytopenia treated with prednisone over 2 months was admitted to emergency intensive care unit for acute respiratory failure and a cavity was found on chest computed tomography. Therefore, his trachea was immediately intubated. The patient was treated with a large spectrum of antibiotic regimen, consisting initially of imipenem/cilastatin, moxifloxacin and fluconazole followed by fluconazole, imipenem/cilastatin, vancomycin, trimethoprim–sulphamethoxazole (TMP‐SMZ) and azithromycin. When the polymerase chain reaction analysis of the bronchoalveolar lavage sample revealed P. jiroveciiand A. terreus, all the antibiotics were stopped except TMP‐SMZ, and voriconazole was added. Two weeks later, the patient showed clinical improvement but radiological deterioration. Consequently, caspofungin was started for salvage therapy, then the patient showed gradual clinical improvement. He was discharged with oral voriconazole and TMP‐SMZ. The antifungal treatment was continued for 6 months until complete radiological absorption. In conclusion, early bronchoscopy with bronchoalveolar lavage fluid should be considered in order to diagnose and treat promptly in those treated with corticosteroids combined with immunocompromised and caspofungin could be an appropriate choice for salvage treatment of coinfection by P. jiroveciiand A. terreus. The authors report the first case of coinfection by Aspergillus terreusand Pneumocystis jiroveciipneumonia. First‐line treatment drugs voriconazole and trimethoprim–sulphamethoxazole does not show a good therapeutic effect in their case. Finally, they combine caspofungin as a salvage treatment, and the patient showed clinical improvement. |
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