PMC10443690_01
Microscopic view of lung tissue from the upper lobe of the right lung (HE stain, 10*10). A small mass of fungal mycelium-like structure (black arrow) was seen around the lung tissue, with a relatively uniform thickness of the mycelium, which was considered morphologically as an Aspergillus infection.
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A 44-year-old man patient was admitted to another hospital for hemoptysis and diagnosed with pulmonary aspergillosis based on the pathological result (Figure 1).
Changes in liver enzyme levels and drug trough concentrations during azole treatment. Symbols: *Voriconazole therapy; #Posaconazole therapy.
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Subsequently, the patient was admitted to Tongji Hospital for fungal infection and started antifungal treatment with a standard dose (200 mg twice daily) of intravenous voriconazole for one week without liver enzyme abnormalities (Figure 2). But posaconazole trough concentrations were below the therapeutic range (>=1.0 mug/mL) according to weekly therapeutic drug monitoring (TDM) (Figure 2).
Changes in the images of the upper lobe of the right lung shown on chest CT before and after pulmonary Aspergillus infection and during antifungal procedures. Image (A) shows a chest CT image before the Aspergillus infection. Images (B-D) are chest CT images after the Aspergillus infection, representing images after 2, 4, and 5 months of antifungal therapy. Images (A-D) all show irregular nodular shadows in the upper lobe of the right lung with cavity formation. Images (A and B) show lesions of approximately similar extent but with increased density and fungus ball formation. Images (B-D) all show fungus ball formation but gradual resorption of the lesion.
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During antifungal therapy, the patient's symptoms gradually resolved, and chest computed tomography (CT) showed gradual resorption of the lesion in the upper lobe of the right lung (Figure 3). 