Cases crib sheet
Case BM - He was recommenced on itraconazole and gradually improved. Again there was a fall of his total IgE to 9,700 IU/L with his Aspergillus specific RAST at 95 kUa/L.
Case JC – Continue posaconazole
Case MR - In April 2010 she was commenced on voriconazole. Unfortunately after two days of therapy she developed an abnormal heart beat with palpitations and she felt she was going to faint. This was in association with significant ocular side effects. She also had a peculiar feeling in her abdomen as if her stomach had “tightened up”. She stopped therapy and was reviewed in clinic the following Friday and most of these symptoms had resolved, although she still has some residual side effects.
Case BMcI - She was admitted for intravenous amphotericin B therapy for 3 weeks, Her sputum during admission grew A. fumigatus, which was later found to be pan-azole resistant (MICs to itraconazole, voriconazole and posaconazole >8mg/L).
What now?
Case CA He was admitted for bronchial artery embolisation, IV Ambisome and IV antibiotics. After two doses of 3mg/Kg of IV Ambisome his creatinine rose to183 umol/L resulting in the need to stop this treatment. He was given appropriate IV rehydration. His bronchial artery embolisation was deferred until his renal function improved sufficiently to do this procedure. It was attempted on the 23rd December but the source of bleeding was not identified. Several vessels were of small calibre and could not be catheterised. Repeat embolisation is planned following a CT thoracic angiogram.
Case CER - She is a candidate for a right upper lobectomy and this has been discussed with her and her husband. However, given the social circumstances with three small children at home, a husband who works extremely hard and is often away from home from 7am until 8pm and lack of provision of child care and risks associated with surgery she is reluctant to contemplate this at the current time. Her MRC score is 1. In May her SGRQ score was 48 and this was unchanged in Oct 2010 (49.9). She successfully underwent a RUL lobectomy, taking 9 months to fully recover post-operatively.