Hydrocortisone
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Invasive pulmonary aspergillosis: case report A 66-year-old man developed invasive pulmonary aspergillosis (IPA) following treatment with hydrocortisone for septic shock. The heavy smoker man who had a history of arterial hypertension, type 2 diabetes, cerebrovascular accident and COPD admitted to the emergency department due to worsening of dyspnoea associated with fever. Based on relevant investigations, he was diagnosed with Legionella pneumophila serogroup 1 pneumonia. For its management, he received cefotaxime, spiramycin and levofloxacin. Meanwhile, he received oxygen therapy and was transferred to the ICU for intubation. However, he became haemodynamically unstable with clinical and biological disseminated intravascular coagulation and developed septic shock. For septic shock, he received hydrocortisone 200 mg/day [route not stated]. Nine days later, as he did not show any improvement, new microbiological tests were performed. Serum β-(1,3)-glucan (BD) and galactomannan (GM) were strongly positive. On direct examination, fungal hyphae were observed and Aspergillus fumigatus was isolated on bronchoalveolar lavage fluid analysis [time to reaction onset not stated]. On the basis of susceptibility testing, the man was treated with piperacillin/tazobactam and amphotericin-B-liposomal. A chest CT was evident for an IPA. For IPA, his hydrocortisone treatment, Legionella pneumonia, COPD and septic shock were considered as contributing factors. He had haemodynamic and respiratory deterioration. Finally, 15 days after the ICU admission, he died [immediate cause of death not stated]. Coulon P, et al. Invasive pulmonary aspergillosis in an ICU patient with Legionnaires' disease: A diagnostic challenge. Journal de Mycologie Medicale 30: No. 3, Sep 803504792 2020. Available from: URL: http://doi.org/10.1016/j.mycmed.2020.100985
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Reactions 3 Oct 2020 No. 1824
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