Invasive pulmonary aspergillosis diagnosed by broncho-alveolar lavage.

1 of 2 DESCRIPTION A 72-year-old woman was admitted to our hospital in August 2011 with a 5-day history of fever. She had been taking predonisolone at 10 mg/day for several years as treatment for autoimmune thrombocytopaenia. On admission, she was febrile with a body temperature of 38.5°C, and peripheral oxygen saturation was 88% in room air. Serum β-D-glucan and galactomannan (GM) testing yielded negative results. Chest radiography on admission showed reticulonodular infi ltration, particularly in both lower fi elds ( fi gure 1 ). CT of the chest showed sparsely distributed ground-glass alveolar opacities with patchy consolidation ( fi gure 2 ). Therapy was initiated with broad-spectrum antibiotics (pazufl oxacin), but respiratory status continued to deteriorate. Bronchoscopy was then performed 4 days after admission. Positive results were obtained for GM testing of broncho-alveolar lavage (BAL) fl uid (>5.0), while culture of BAL fl uid yielded negative results. Invasive pulmonary aspergillosis (IPA) was thus diagnosed. Therapy was initiated with 3 mg/kg/day liposomal amphotericin B, leading to immediate improvements in both radiological fi ndings and hypoxaemia. In this case, typical radiological fi ndings of IPA on CT, such as dense, well-circumscribed lesions with a halo sign, were not evident and serum β-Dglucan and GM testing yielded negative results. BAL GM can be useful for early diagnosis of IPA in haematological malignancies with pulmonary infi ltrates. 1