2.2 Case 2
A-36-year-old woman was admitted to the hospital due to repeated coughing and expectoration for 11 years and aggravating for half a year. 11 years ago, she was diagnosed with bronchiectasis, and Mycobacterium intracellulare was found by sputum culture. She visited the local hospital for many times. 5-month ago, she found the sputum was thick and wire drawing. Fluconazole was added and the anti-mycobacterial treatment strategies were adjusted without clinical improvement. She was seen in the outpatient clinic 10 days prior for hemoptysis and viscous sputum. A moderate amount of S. apiospermum was found by sputum culture, then antifungal drug was switched to oral voriconazole (200mg, twice daily). This treatment resulted into clinical improvement, and the sputum was easy to cough up and the amount decreased. A moderate amount of S. apiospermum were still detected from sputum samples after 4-month treatment. TDM of voriconazole was performed and the outcome revealed 2.7 μg·mL-1. There was no fungi detected again in the next 3 months. However, a large amount of S. apiospermum were still detected from sputum samples after treating with voriconazole for 12-month. Then voriconazole was replaced by posaconazole and continuing therapy for a month and a half, S. apiospermum was not detected again and posaconazole was discontinued. In the next 6 months, S. apiospermum was still founded intermittently from sputum culture, but her clinical symptoms and radiological findings did not significantly worsen and no antifungal therapy was performed again.