Fatal Drug-Resistant Invasive Pulmonary Aspergillus fumigatus in a 56-Year-Old Immunosuppressed Man
Immune status, severity or burden of disease, appropriate dosing of medication, and drug resistance are important considerations when treating immunosuppressed patients.
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner,Frontline Medical Communications Inc., the US Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
Dr. Albert is a Physician at the Veterans Affairs Puget Sound Healthcare System in Seattle, Washington. Dr. Seaburg is a Senior Fellow in the Division of Pulmonary and Critical Care Medicine, Dr. Hill is an Acting Assistant Professor in the Division of Allergy and Infectious Disease, and Dr. Albert is a Clinical Instructor in the Division of General Internal Medicine, all in the Department of Medicine at the University of Washington School of Medicine. Correspondence:Dr. Albert (tyler.albert@va.gov)
Conclusion
This fatal case of invasive pulmonary aspergillosis illustrates the importance of considering the 4 main causes of treatment failure in an infection. Although the patient had a high burden of disease with a rare resistance pattern, he was treated with appropriate and well-dosed therapy. Ultimately, his unmodifiable immunosuppression was likely the driving factor leading to treatment failure and death. The indication for and number of bone marrow transplants continues to increase, thus exposure to and treatment of invasive fungal infections will increase accordingly. As such, providers should ensure that all causes of treatment failure are considered and addressed.
