Lobectomy for invasive pulmonary aspergillosis in neutropenic children with aplastic anemia: a case report

Abstract

Invasive pulmonary aspergillosis (IPA) is a life-threatening infectious complication in neutropenic patients with hematologic diseases. Although there is no widely accepted standard treatment strategy, lobectomy is required when antifungal prophylaxis fails to control a pulmonary fungal ball in an existing pulmonary cavity. We report the successful lobectomy for IPA in a patient on combined immunosuppressive therapy (IST) as an integral part of induction of cord blood transplantation (CBT). A 12-year-old girl with aplastic anemia showed persistent fever and cough of lung origin with classical roentgenographic signs of aspergilloma following the finding of left upper pulmonary lobe infiltration. Left upper lobectomy for treatment was selected considering the uncontrollable fungal infection despite antifungal agent therapy. Dense pleural adhesions adjacent to the fungal ball settling within a cavity were observed. Her postoperative course was uneventful, and the patient received CBT induction 33 days after surgery.