Rare Infant Case of Pulmonary Aspergilloma Highlighting Common Challenges With Voriconazole Dosing.
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| Abstract |
We describe a 6-week-old male-term infant with a pulmonary aspergilloma diagnosed following lobectomy for suspected pleuropulmonary blastoma, with characteristic histopathologic findings and Aspergillus detected by polymerase chain reaction. Intensive testing did not reveal primary or secondary immunodeficiency. During 5 weeks treatment with voriconazole including regular therapeutic drug monitoring and dose adjustment, a level in the target range was never achieved. When the patient developed photosensitivity, treatment was stopped without relapse over 12 months follow-up. Voriconazole dosing is notoriously challenging in children. We review the cumulative published experience with voriconazole use in infants to highlight even greater difficulty in infants. Pulmonary aspergillosis is typically a disease affecting immunocompromised or critically ill patients. In children, it is well described in those with chronic granulomatous disease (CGD) as a complication of immunosuppressive antineoplastic chemotherapy and rarely in extremely- or very-low birthweight premature neonatal intensive care patients. The diagnosis is extremely rare in children without underlying risk factors. To our knowledge, this is the first report of a pulmonary aspergilloma in an immunocompetent infant.
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| Authors | Yara-Natalie Abo, Amanda Gwee, Joshua Osowicki |
| Journal | The Pediatric infectious disease journal (Pediatr Infect Dis J) Vol. 40 Issue 3 Pg. 227-230 (03 01 2021) ISSN: 1532-0987 [Electronic] United States |
| PMID | 33565811 (Publication Type: Case Reports, Journal Article) |
| Copyright | Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. |
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