A case of invasive pulmonary aspergillosis diagnosed by transbronchial lung biopsy during treatment for diabetic ketoacidosis in a type 1 diabetic patient

J Infect Chemother. 2020 Feb;26(2):274-278. doi: 10.1016/j.jiac.2019.08.011. Epub 2019 Sep 19.

Abstract

Invasive pulmonary aspergillosis (IPA) patients with non-hematological malignancy are far less than with hematological malignancy patients. We encountered a very rare case of IPA in which type 1 diabetes was the only conceivable risk factor. Further, according to the diagnostic categories of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria for IPA, the frequency of proven diagnosis is very low. Here we report a proven IPA, which rapidly developed when the patient with type 1 diabetes was being treated for diabetic ketoacidosis, which was successfully treated with the combination therapy of voriconazole (VRCZ) and micafungin (MCFG), based on early diagnosis using bronchoscopy.

Keywords: Bronchoscopy; Proven invasive pulmonary aspergillosis; Type 1 diabetes mellitus.

Publication types

  • Case Reports

MeSH terms

  • Antifungal Agents / therapeutic use
  • Aspergillus fumigatus / isolation & purification*
  • Biopsy / methods
  • Bronchoalveolar Lavage Fluid / microbiology
  • Bronchoscopy / methods
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / drug therapy
  • Diabetes Mellitus, Type 1 / microbiology
  • Diabetic Ketoacidosis / complications*
  • Diabetic Ketoacidosis / drug therapy
  • Diabetic Ketoacidosis / microbiology
  • Drug Therapy, Combination
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Insulin / therapeutic use
  • Invasive Pulmonary Aspergillosis / complications
  • Invasive Pulmonary Aspergillosis / diagnosis*
  • Invasive Pulmonary Aspergillosis / drug therapy
  • Invasive Pulmonary Aspergillosis / microbiology
  • Male
  • Micafungin / therapeutic use
  • Middle Aged
  • Risk Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Voriconazole / therapeutic use

Substances

  • Antifungal Agents
  • Hypoglycemic Agents
  • Insulin
  • Voriconazole
  • Micafungin