2.1 Case 1
A 43-year-old woman was admitted to the hospital with cough and
expectoration of sputum with hemoptysis for more than a year and a half.
She was previously diagnosed with bronchiectasis and hemoptysis and was
hospitalized several times. Ten months ago, she underwent left pulmonary
bullectomy, but the symptoms of cough and sputum still existed. Her
symptoms worsened two month prior and bronchoscopy examination was
performed. Next-generation sequencing (NGS) of bronchoalveolar lavage
(BAL) revealed 87 copies of S. apiospermum and 1 copy of
Aspergillus. Oral treatment with voriconazole was initiated at a dose of
350mg twice daily. The patient was still coughing and expectorating
sputum repeatedly during the treatment. Computed tomography (CT) of the
chest revealed the lesions progressed after one month therapy and he was
admitted to hospitalization with the diagnosis of bronchiectasis and
infection, pulmonary fungal infection (Sedosporium ), and left
pulmonary bullectomy, continuing oral voriconazole after admission.
Physical examination revealed her body temperature was 36.3℃, heart rate
was 82 times per minute, breathing rate was 14 times per minute, her
blood pressure was 96/58mmHg and her body weight was 45kg. The breath
sounds of both side lungs were slightly coarse, and no obvious wet or
dry rales were heard. Bronchoscopy examination was performed after
admission. Mycobacterium tuberculosis smear examination found acid-fast
bacilli. NGS of BAL presented 45 sequences of Mycobacterium abscessus,
and no Sedosporium was detected again. Therapeutic drug
monitoring (TDM) of voriconazole revealed 2.8 μg·mL-1.
The patient was then suggested to treat in department of Infectious
Diseases and discharged. Four days later, he was seen in the Department
of Infectious Diseases and started anti-Mycobacterium abscessus
treatment. Voriconazole was discontinued meantime with a treatment
course of 2-months. No Sedosporium was detected in 8 months
following. Her symptoms were improved after treatment, but there was no
obvious change in imaging.