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.