Peripheral eosinophilia and eosinophilic colitis during long-term azole therapy for pulmonary aspergillosis.

Barbara Grzegorczyk,Yoshihiko Murata

doi:10.1099/jmmcr.0.004135

Barbara Grzegorczyk, Yoshihiko Murata

Open Access

https://doi.org/10.1099/jmmcr.0.004135

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Abstract

Introduction:Voriconazole and posaconazole are often used to treat invasive Aspergillus infections. We describe a patient with chronic pulmonary aspergillosis (CPA) who experienced peripheral eosinophilia and eosinophilic colitis while on voriconazole, and also experienced gastrointestinal symptoms and recurrent eosinophilia while on subsequent posaconazole therapy.Case presentation:A 75-year-old female with recurrent pulmonary mucus plugs due to CPA was treated with long-term oral voriconazole. The patient had no clinical evidence of CPA exacerbations while on such antifungal treatment but developed peripheral eosinophilia, diarrhoea and eosinophilic colitis after >5 years of voriconazole therapy that resolved after cessation of azole therapy. Due to a CPA exacerbation after stopping voriconazole, the patient was started on posaconazole as an alternative CPA therapy. However, after 15 months, the patient developed a recurrence of peripheral eosinophilia and diarrhoea while on posaconazole.Conclusion:Long-term use of voriconazole and posaconazole can be used successfully to reduce the incidence of CPA exacerbations. However, such antifungal therapy may also lead to peripheral eosinophilia, diarrhoea and eosinophilic colitis.

Highlights

Voriconazole and posaconazole are often used to treat invasive Aspergillus infections
Voriconazole and posaconazole are often used for off-label treatment of Aspergillus infections such as chronic pulmonary aspergillosis (CPA) (Nagappan & Deresinski, 2007; Saravolatz et al, 2003)
We report a case of a patient with CPA who developed peripheral eosinophilia and eosinophilic colitis after 5 years of oral voriconazole therapy

Summary

Introduction

Voriconazole and posaconazole are often used for off-label treatment of Aspergillus infections such as chronic pulmonary aspergillosis (CPA) (Nagappan & Deresinski, 2007; Saravolatz et al, 2003). A chest X-ray revealed right lower and middle lobe collapse due to mucus plugs that were removed during bronchoscopy and subsequently grew Aspergillus terreus As her recurrent respiratory symptoms strongly suggested a recrudescence of CPA while off antifungal therapy, the patient was started on oral posaconazole 200 mg twice daily instead of the labelled dosing (in the USA) of 200 mg three times daily (Nagappan & Deresinski, 2007). The dose reduction of posaconazole was discussed with the hospital pharmacy and agreed with the patient, and was primarily due to her age (80 years old at the start of posaconazole therapy) and weight (,45 kg), and after careful discussion with the patient regarding the potential benefits versus the risk of cross-reactive adverse events, i.e. eosinophilia, while on posaconazole She was asymptomatic for 15 months but presented with a 2-week history of progressive diarrhoea and concurrent peripheral eosinophilia of 15 %. At the time of writing, the patient remains asymptomatic and off antifungal therapy

Conclusion

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