Respir Case Rep. 2021; 10(2): 101-104 | DOI: 10.5505/respircase.2021.77044

Aspergillozis: Allerjik Bronkopulmoner Aspergillus'tan Ýnvazif Aspergillozis'e

Damla Serçe Unat¹, Aysu Ayrancý¹, Gülru Polat¹, Gülistan Karadeniz¹, Ömer Selim Unat², Fatma Demirci Üçsular^1
1Saðlýk Bilimleri Üniversitesi Dr. Suat Seren Göðüs Hastalýklarý ve Cerrahisi Eðitim ve Araþtýrma Hastanesi, Ýzmir
²Ege Üniversitesi Týp Fakültesi, Göðüs Hastalýklarý Anabilim Dalý, Ýzmir

Allerjik Bronkopulmoner Aspergillozis (ABPA), havayollarýnýn Aspergillus fumigates ile kolonizasyonuna yanýt olarak geliþen kompleks bir hipersensitivite reaksiyonudur. Aspergillus türleri doðada pek çok yerde bulunur ve enfeksiyöz konidyumlarýn inhalasyonu sýk görülen bir olaydýr. Ancak, doku invazyonu nadirdir. Doku invazyonu en sýk olarak hematolojik malignite ya da solid organ transplantasyonu için immünsüpresif tedavi alan hastalarda görülür. Elli sekiz yaþýnda erkek hasta 1 hafta önce baþlayan, dispne, öksürük ve hemoptizi þikâyeti ile baþvurdu. On bir ay önce ABPA tanýsý ile oral kortikosteroid ve itrakanazol tedavisi baþlanan hastanýn, bilgisayarlý tomografisi ve laboratuvar bulgularý, invazif aspergillozis olarak deðerlendirildi. Bronþ aspirasyonunda aspergillus fumigatus üreyen hastaya intravenöz vorikanozol baþlandý. Takiplerinde genel durumu kötüleþen hasta yoðun bakýma nakil verildi. Fakat yoðun bakým yatýþýnýn 3. gününde exitus oldu. Birçok hastalýðýn tedavisinde kullanýlan sistemik kortikosteroidler, immünosupresif özellikleri nedeniyle dikkatli kullanýlmalýdýr. Bu nedenle, ABPA tedavisinde sistemik kortikosteroid kullanýmý, dikkatle yönetilmesi gereken bir tedavi þeklidir.

Anahtar Kelimeler: Allerjik Bronkopulmoner Aspergillozis, Ýnvazif Aspergillozis, Steroid.

---

Aspergillosis: from Allergic Bronchopulmonary Aspergillosis to Invasive Aspergillosa

Damla Serçe Unat¹, Aysu Ayrancý¹, Gülru Polat¹, Gülistan Karadeniz¹, Ömer Selim Unat², Fatma Demirci Üçsular^1
1University of Health Science Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, Ýzmir, Turkey
²Departmant of Pulmonology, Ege University, Ýzmir, Turkey

Allergic Bronchopulmonary Aspergillosis (ABPA) is a complex hypersensitivity reaction that develops in response to the colonization of the airways with Aspergillus fumigates. Aspergillus species are found in many places in nature, and while the inhalation of infectious conidia is a common occurrence, tissue invasion is rare, occurring most frequently in patients undergoing immunosuppressive therapy for hematological malignancy or solid organ transplantation. A 58-year-old male patient presented with dyspnea, cough and hemoptysis that had started 1 week earlier. The patient had been started on oral corticosteroid and itracanazole treatment following a diagnosis of ABPA 11 months previously. Computed tomography and laboratory findings were evaluated as invasive aspergillosis. Aspergillus fumigatus was identified in bronchial aspiration, and intravenous voriconasole was started. The patient’s general condition worsened during follow-up and was transferred to intensive care, but died on the 3rd day of ICU hospitalization. Systemic corticosteroids applied for the treatment of many diseases should be used with caution due to their immunosuppressive properties, and the use of systemic corticosteroids in the treatment of ABPA must be carefully managed.

Keywords: Allergic Bronchopulmonary Aspergillosis, Invasive Aspergilosis, Steroid.

---

ATIF KOPYALA