Necrotizing pneumonia due to Aspergillus and Salmonella after immune checkpoint inhibitor treatment: An unusual case and review of the literature

IF 1.5 4区生物学 Q4 MYCOLOGY Revista Iberoamericana De Micologia Pub Date : 2023-04-01 DOI:10.1016/j.riam.2023.05.001

Muhammed Cihan Işık , Oğuz Karcıoğlu , Gülşen Hazırolan , Dolunay Gülmez , Mehmet Ruhi Onur , Mehmet Mahir Kunt , Sevtap Arikan-Akdagli , Gökhan Metan

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Abstract

Background

Immune checkpoint inhibitors (ICIs) are a promising new treatment for different types of cancer. The infectious complications in patients taking ICIs are rare.

Case report

A 58-year-old male who received chemotherapy consisting of pembrolizumab (PD-1 inhibitor) for esophagus squamous cell carcinoma one month before was admitted to the emergency room with shortness of breath soon after fiberoptic bronchoscopy, which was done for the inspection of the lower airway. A computed tomography of the chest revealed a progressive consolidation on the right upper lobe. Salmonella group D was isolated from the bronchoalveolar lavage (BAL) fluid culture. The fungal culture of the same clinical sample yielded Aspergillus niger; furthermore, a high titer (above the cut-off values) of Aspergillus antigen was found both in the BAL fluid and serum of the patient. Despite the effective spectrum and appropriate dose of antimicrobial treatment, the patient died due to disseminated intravascular coagulopathy.

Conclusions

Awareness of unusual pathogens in the etiology of pneumonia after ICI treatment may help to avoid underdiagnosis.

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免疫检查点抑制剂治疗后曲霉和沙门氏菌引起的坏死性肺炎:一个不寻常的病例和文献回顾

免疫检查点抑制剂(ICIs)是一种很有前景的治疗不同类型癌症的新方法。注射ICIs患者的感染并发症很少见。病例报告:一名58岁男性患者在一个月前接受了由派姆单抗(PD-1抑制剂)组成的食管鳞状细胞癌化疗，在进行纤维支气管镜检查后不久因呼吸急促而入住急诊室，该检查是为了检查下气道。胸部计算机断层扫描显示右上肺叶进行性实变。从支气管肺泡灌洗(BAL)液培养中分离出D组沙门氏菌。同一临床样品的真菌培养产生黑曲霉;此外，在患者的BAL液和血清中发现了高滴度(高于临界值)的曲霉抗原。尽管抗菌药物治疗有效且剂量合适，患者还是死于弥散性血管内凝血病。结论对ICI治疗后肺炎病因中异常病原体的认识有助于避免漏诊。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Revista Iberoamericana De Micologia MYCOLOGY-

CiteScore

1.90

自引率

0.00%

发文量

审稿时长

81 days

期刊介绍： Revista Iberoamericana de Micología (Ibero-American Journal of Mycology) is the official journal of the Asociación Española de Micología, Asociación Venezolana de Micología and Asociación Argentina de Micología (The Spanish, Venezuelan, and Argentinian Mycology Associations). The Journal gives priority to publishing articles on studies associated with fungi and their pathogenic action on humans and animals, as well as any scientific studies on any aspect of mycology. The Journal also publishes, in Spanish and in English, original articles, reviews, mycology forums, editorials, special articles, notes, and letters to the editor, that have previously gone through a scientific peer review process.