Antineoplastics
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Reactions 1388 - 11 Feb 2012 S Antineoplastics Invasive pulmonary aspergillosis: case report A 27-year-old man with testicular cancer developed invasive pulmonary aspergillosis during chemotherapy with bleomycin, etoposide, cisplatin, vinblastine and ifosfamide [routes not stated; time to reaction onset not clearly stated]. The man received four 21-day cycles of first-line chemotherapy with bleomycin 30U, etoposide 100 mg/m 2 and cisplatin 20 mg/m 2 . Due to maintenance of high serum alpha fetoprotein levels, treatment was switched to 28-day cycles of second-line chemotherapy with vinblastine 5 mg/m 2 , ifosfamide 1200 mg/m 2 and cisplatin 20 mg/m 2 . During the second-line chemotherapy, he developed neutropenia and lymphopenia; he had grade 4 neutropenia 3 days after the second cycle. He presented with dry cough, dyspnoea and fever, along with signs of tachycardia and tachypnoea. The man started empirical therapy with piperacillin/ tazobactam, but his fever and radiological abnormalities had persisted 11 days later. His condition worsened with a greater degree of dyspnoea and respiratory failure. He had received pegfilgrastim after chemotherapy, and had recovered from neutropenia 6 days later. However, examinations now showed neutropenia, lymphopenia and an elevated C-reactive protein level. A diffuse ground-glass pattern, predominantly in the left upper pulmonary lobe, was noted on a CT scan. Oedema and bronchial mucosa irregularity at the main carina and left main bronchus were observed on bronchoscopy. Bronchoalveolar lavage revealed neutrophilic alveolitis and inflammatory infiltrate, and was positive for Aspergillus fumigatus and Aspergillus DNA. Invasive pulmonary aspergillosis was diagnosed, and he started receiving voriconazole. He was afebrile 3 days later, and was later discharged without hypoxaemia, but with dyspnoea. His dyspnoea and chest radiological abnormalities progressively resolved on follow-up. A repeat CT scan showed progressive resolution of ground- glass pattern, and a repeat bronchoscopy revealed normal findings. Bronchoalveolar lavage and sputum cultures yielded negative results for Aspergillus. Saleiro S, et al. Invasive pulmonary aspergillosis in a patient with seminomatous testicular cancer. Mycoses 54 (Suppl. 4): 16-19, No. 4, Dec 2011. Available from: URL: http://dx.doi.org/10.1111/j.1439-0507.2011.02138.x - Portugal 803066803 1 Reactions 11 Feb 2012 No. 1388 0114-9954/10/1388-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1388 - 11 Feb 2012
SAntineoplastics
Invasive pulmonary aspergillosis: case reportA 27-year-old man with testicular cancer developed
invasive pulmonary aspergillosis during chemotherapywith bleomycin, etoposide, cisplatin, vinblastine andifosfamide [routes not stated; time to reaction onset notclearly stated].
The man received four 21-day cycles of first-linechemotherapy with bleomycin 30U, etoposide 100 mg/m2
and cisplatin 20 mg/m2. Due to maintenance of high serumalpha fetoprotein levels, treatment was switched to 28-daycycles of second-line chemotherapy with vinblastine5 mg/m2, ifosfamide 1200 mg/m2 and cisplatin 20 mg/m2.During the second-line chemotherapy, he developedneutropenia and lymphopenia; he had grade 4 neutropenia3 days after the second cycle. He presented with dry cough,dyspnoea and fever, along with signs of tachycardia andtachypnoea.
The man started empirical therapy with piperacillin/tazobactam, but his fever and radiological abnormalitieshad persisted 11 days later. His condition worsened with agreater degree of dyspnoea and respiratory failure. He hadreceived pegfilgrastim after chemotherapy, and hadrecovered from neutropenia 6 days later. However,examinations now showed neutropenia, lymphopenia andan elevated C-reactive protein level. A diffuse ground-glasspattern, predominantly in the left upper pulmonary lobe,was noted on a CT scan. Oedema and bronchial mucosairregularity at the main carina and left main bronchus wereobserved on bronchoscopy. Bronchoalveolar lavagerevealed neutrophilic alveolitis and inflammatory infiltrate,and was positive for Aspergillus fumigatus and AspergillusDNA. Invasive pulmonary aspergillosis was diagnosed, andhe started receiving voriconazole. He was afebrile 3 dayslater, and was later discharged without hypoxaemia, butwith dyspnoea. His dyspnoea and chest radiologicalabnormalities progressively resolved on follow-up. Arepeat CT scan showed progressive resolution of ground-glass pattern, and a repeat bronchoscopy revealed normalfindings. Bronchoalveolar lavage and sputum culturesyielded negative results for Aspergillus.Saleiro S, et al. Invasive pulmonary aspergillosis in a patient with seminomatoustesticular cancer. Mycoses 54 (Suppl. 4): 16-19, No. 4, Dec 2011. Available from:URL: http://dx.doi.org/10.1111/j.1439-0507.2011.02138.x - Portugal 803066803
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Reactions 11 Feb 2012 No. 13880114-9954/10/1388-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
