2021 Volume 58 Issue 5 Pages 446-449
A 5-year-old girl with FUS-ERG-positive acute myeloid leukemia failed to achieve remission despite chemotherapy, resulting in prolonged agranulocytosis for two months. She developed cough, fever and back pain, and was diagnosed as having invasive pulmonary aspergillosis (IPA) on the basis of chest CT images showing abscess in the left lung and her positivity for the serum galactomannan antigen. Her symptoms gradually improved with the combination of voriconazole (VRCZ) and micafungin (MCFG); however, massive hemoptysis occurred on the 16th day of the antifungal therapy. Contrast-enhanced CT revealed a pseudoaneurysm on the left intercostal artery adjacent to the IPA lesion. Urgent arterial embolization successfully prevented hemoptysis, followed by the left upper pulmonary segmentectomy. Two months after, she received allogeneic hematopoietic cell transplantation (HCT) concurrently with VRCZ. The IPA did not recur for 12 months after HCT. Multidisciplinary management consisting of arterial embolization and surgery was effective for IPA with massive hemoptysis.
