Video interview with patient with an aspergilloma and chronic pulmonary aspergillosis, diagnosed after coughing up blood who later developed azole resistance on voriconazole. Patient History This patient had severe kyphoscoliosis as a child with insertion of spinal rods in early adulthood. She is a life-long non-smoker. She first presented in 2001 with an irritating cough and several treatments with antibiotics failed to alleviate it. After 2 years the cough worsened and she developed a fever. She was investigated but results were inconclusive. She then coughed up large amounts of blood (haemoptysis) and had a very severe bleed which was treated with embolisation and oral tranexamic acid. She continued to cough and produce green sputum and lose weight. Aspergillus precipitin titre was high and she was initially diagnosed with chronic pulmonary aspergillosis with one cavity containing an aspergilloma. Treatment with itraconazole did not alleviate her symptoms (despite adequate blood levels) and she started voriconazole and considerable improvement was seen initially and she gained some weight. She continued voriconazole for 2 years. However her Aspergillus titre remained high and her cough continued. Further tests showed her trough plasma levels of voriconazole to be more than 0.5mg/L, however isolates revealed that her Aspergillus fumigatus was drug resistant to itraconazole, voriconazole and posaconazole. The patient has now commenced amphotericin B therapy. We thank the patient for kindly providing this interview.
Patients and general interest