Abstract
The patient was a 6-year-old girl with acute lymphoblastic leukemia (ALL). During induction chemotherapy, fever and thoracic pain occurred with increased plasma β-D-glucan and plasma Aspergillus DNA despite prophylactic administration of antibiotics and fluconazole. Thoracic computed tomography (CT) revealed an abscess and infiltration in the right S3 area, suggesting diagnosis of invasive pulmonary aspergillosis. Although administration of micafungin (MCFG) temporarily improved the symptoms, the lung abscess then spread with infiltration involving the right S4, S5, and S9 areas, which required additional administration of amphotericin B, itraconazole, and granulocyte colony-stimulating factor. With additional antifungal agents, plasma β-D-glucan and plasma Aspergillus DNA became negative, and thoracic CT showed improvement of the lung abscess and infiltration. Complete remission of ALL was sustained during the 6 months of chemotherapy interruption, and currently, additional chemotherapy has been resumed. Combination therapy with MCFG and other antifungal agents may be useful for treating refractory pulmonary aspergillosis with respect to efficacy and safety.
