A case of early diagnosis of invasive pulmonary aspergillosis, based on elevated (1→3)-β-D-glucan level, during immunosuppressive treatment for interstitial pneumonia

Abstract

We report a case of a 77-year-old male with chronic interstitial pneumonia, who was on prednisolone and cyclosporine. On a regular visit, he complained of sputum production and general fatigue, and was initially diagnosed as having bacterial pneumonia on the basis of clinical and imaging findings. However, an in-hospital examination revealed an elevation of plasma β-D-glucan levels; thus, he was admitted to the hospital on the same day with suspected deep-seated mycoses. Subsequently, Aspergillus nidulans was detected from sputum cultures, and the patient was subsequently diagnosed as having invasive pulmonary aspergillosis (IPA) on the basis of clinical findings and serum test findings. He was administered antifungal drugs including micafungin, voriconazole, and itraconazole, after which he recovered. In general, the clinical course of IPA is acute and has a poor prognosis. Thus, rapid diagnosis and early initiation of appropriate antifungal agents are crucial in treating IPA. In this case, a prompt result of the β-D-glucan test owing to an in-hospital examination led to an early diagnosis of IPA and immediate appropriate antifungal therapy.