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A 23 Age - year Age - old Age man Sex with a history of severe Disease_disorder aplastic Disease_disorder anemia Disease_disorder ( SAA Disease_disorder ) underwent bone Therapeutic_procedure marrow Therapeutic_procedure transplantation Therapeutic_procedure from his HLA Detailed_description - haploidentical Detailed_description mother Subject in January Date 2014 Date .
The conditioning regimens consisted of busulphan Medication cyclophosphamide Medication and antithymocyte Medication globulin Medication (BUCY+ATG) (10).
Cyclosporine Medication A Medication ( CsA Medication ) and short Detailed_description - term Detailed_description methotrexate Medication ( MTX Medication ) plus mycophenolate Medication mofetil Medication ( MMF Medication ) were used as prophylaxis against graft Disease_disorder - versus Disease_disorder - host Disease_disorder disease Disease_disorder ( GVHD Disease_disorder ) (11).
Standard measures were adopted for the prevention of infectious Disease_disorder complications Disease_disorder , which included fluconazole Medication for antifungal Detailed_description prophylaxis Therapeutic_procedure and acyclovir Medication to prevent herpes Detailed_description - related Detailed_description infections Disease_disorder .
A hemogram Diagnostic_procedure revealed the reconstruction Sign_symptom of Sign_symptom granulocytes Sign_symptom (ANC>0.5×109/L) on day Date +12 Date post- transplantation Therapeutic_procedure .
The patient developed grade Detailed_description II Detailed_description acute Detailed_description GVHD Disease_disorder of the skin Biological_structure on day Date +42 Date post- transplantation Therapeutic_procedure .
This was treated by treatment with a standard Dosage - dose Dosage of methyl Medication - prednisolone Medication , which achieved a complete Sign_symptom response Sign_symptom ( CR Sign_symptom ).
The patient's chronic Disease_disorder GVHD Disease_disorder ( cGVHD Disease_disorder ) of the skin Biological_structure gradually progressed from day Date +100 Date post- transplantation Therapeutic_procedure and he was treated with prednisolone Medication and CsA.
On day Date 120 Date post- transplantation Therapeutic_procedure , he complained of a cough Sign_symptom and antibiotics Medication were administered.
A blood Diagnostic_procedure analysis Diagnostic_procedure revealed the following: WBC Diagnostic_procedure , 2.34×109/L Lab_value ; ANC Diagnostic_procedure , 1.72×109/L Lab_value ; hemoglobin Diagnostic_procedure , 85 Lab_value g/L Lab_value ; and platelets Diagnostic_procedure , 72×109/L.
Although both a chest Biological_structure computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) scan and tests Diagnostic_procedure for Diagnostic_procedure pathogens Diagnostic_procedure via Detailed_description routine Detailed_description culturing Detailed_description , including blood Detailed_description tests for Beta Diagnostic_procedure - D Diagnostic_procedure glucan Diagnostic_procedure ( G Diagnostic_procedure - test Diagnostic_procedure ) and Galactomannan Diagnostic_procedure ( GM Diagnostic_procedure - test Diagnostic_procedure ) were all negative Lab_value , the patient's cough Sign_symptom did not respond to antibiotics Medication and we empirically initiated treatment with voriconazole Medication ( 6 Dosage mg/kg/12h Dosage for Dosage the Dosage first Dosage day Dosage , followed by 4 Dosage mg/kg/12h Dosage ).
Liver Biological_structure toxicity Sign_symptom occurred during voriconazole Medication treatment, thus the anti Therapeutic_procedure - fungal Therapeutic_procedure regimen Therapeutic_procedure was changed to micafungin Medication ( 100 Dosage mg/d Dosage ).
However, the persistent Detailed_description cough Sign_symptom did not improve and hoarseness Sign_symptom developed after Date two Date weeks Date of treatment - ulcers Sign_symptom were then observed in the throat Biological_structure by laryngoscopy Diagnostic_procedure (Fig.1a).
The patient developed severe Severity dyspnea Sign_symptom in Date the Date following Date week Date when anti Detailed_description - infection Detailed_description and topical Detailed_description treatments Therapeutic_procedure were applied.
Fiberoptic Detailed_description bronchoscopy Diagnostic_procedure revealed an irregular Detailed_description , nodular Shape material Sign_symptom with white Detailed_description moss Detailed_description , which nearly Detailed_description obstructed Sign_symptom the bronchus Biological_structure ; however, chest Biological_structure CT Diagnostic_procedure imaging was negative Lab_value (Fig.1b and c).
The histopathological Diagnostic_procedure examination Diagnostic_procedure of biopsy Diagnostic_procedure specimens revealed an Aspergillus Disease_disorder species (Fig.1d).
The patient was diagnosed with pseudomembranous Detailed_description Aspergillus Disease_disorder tracheobronchitis Disease_disorder type Detailed_description ITBA Detailed_description based on the results of bronchoscopy Diagnostic_procedure and a pathological Diagnostic_procedure examination Diagnostic_procedure (12).
The antibiotic Medication and micafungin Medication treatments were ceased and liposomal Detailed_description amphotericin Medication B Medication ( liposomal Detailed_description AmB Medication ) was administered daily Dosage at a target dose of 3 Dosage mg/kg Dosage .
The patient's serum Detailed_description creatinine Diagnostic_procedure level rose Lab_value from 60.4 Lab_value μmol/L Lab_value to 168 Lab_value μmol/L Lab_value during Date the Date first Date 7 Date days Date of liposomal Detailed_description AmB Medication treatment.
Due to progressive Severity renal Disease_disorder dysfunction Disease_disorder , the anti Medication - fungal Medication regimen was switched to a combination of posaconazole Medication ( 400 Dosage mg/12 Dosage h Dosage ) and caspofungin Medication [ 50 Dosage mg, Dosage daily Dosage ( 70 Dosage mg Dosage for Dosage the Dosage first Dosage dose Dosage )].
The combination Medication therapy Medication continued for 2 Duration weeks Duration , until the previous nodules Sign_symptom in the throat Biological_structure completely disappeared under bronchoscopy Diagnostic_procedure (Fig.2a); however, a repeat chest Biological_structure CT Diagnostic_procedure scan showed progression Sign_symptom (Fig.2b).
The symptom of dyspnea Sign_symptom gradually progressed, thus fiberoptic Detailed_description bronchoscopy Diagnostic_procedure was performed to remove Therapeutic_procedure the obstructive Sign_symptom material Sign_symptom from the patient's airways Biological_structure once Frequency a Frequency week Frequency for two Duration weeks Duration .
All of the symptoms Sign_symptom were relieved and the final chest Biological_structure CT Diagnostic_procedure scan showed negative Lab_value results before the discontinuation of anti Medication - fungal Medication therapy, and all of the tests Diagnostic_procedure were negative Lab_value for Aspergillus Disease_disorder .
Posaconazole Medication was administered as a secondary prophylactic Therapeutic_procedure treatment Therapeutic_procedure and the patient was discharged Clinical_event from hospital Nonbiological_location .
The patient is still being followed Clinical_event and remains free of any recurrence of invasive Detailed_description fungal Detailed_description infection Disease_disorder .