Primary aspergilloma and subacute invasive aspergillosis in two AIDS patients Aspergiloma primário e aspergilose invasiva subaguda em dois pacientes com AIDS

• Published in: Revista do Instituto de Medicina Tropical de São Paulo
• Main Authors: Roberto Martinez, Gleusa de Castro, Alcyone A. Machado, Maria Janete Moya
• Format: Article in Journal/Newspaper
• Language: English
• Published: Universidade de São Paulo (USP) 2009
• Subjects: Aspergilloma; Acquired immunodeficiency syndrome; Central nervous system; Invasive aspergillosis; Neutropenia; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Alta; Arctic
• Online Access: https://doi.org/10.1590/S0036-46652009000100009; https://doaj.org/article/e7cad9891c194601b7c7b1cfa6a3680d

Although uncommon, invasive aspergillosis in the setting of AIDS is important because of its peculiar clinical presentation and high lethality. This report examines two AIDS patients with a history of severe cellular immunosuppression and previous neutropenia, who developed subacute invasive aspergillosis. One female patient developed primary lung aspergilloma, with dissemination to the mediastinum, vertebrae, and spine, which was fatal despite antifungal treatment. The second patient, who had multiple cavitary brain lesions, and eye and lung involvement, recovered following voriconazole and itraconazole, and drugs for increasing neutrophil and CD4+ lymphocyte levels. These cases demonstrate the importance of Aspergillus infections following neutropenia in AIDS patients, and emphasize the need for early and effective antifungal therapy. A aspergilose invasiva em pacientes com aids, embora incomum, é relevante pela apresentação clínica peculiar e alta letalidade. Este relato descreve os casos de dois pacientes com aids com grave imunossupressão celular e neutropenia prévia, os quais tiveram aspergiloma pulmonar primário, com disseminação para mediastino, vértebras e medula espinhal, evoluindo para óbito apesar do tratamento antifúngico. O segundo paciente, que tinha lesões cavitárias múltiplas no cérebro e infecção ocular e pulmonar, recuperou-se após tratamento com voricanazol, itraconazol e com drogas para aumentar o número de neutrófilos e de linfócitos CD4+. Estes casos demonstram o risco de infecção por Aspergillus após episódios de neutropenia em pacientes com aids e alertam para o início precoce de terapia antifúngica eficaz.