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.