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Aspergillus fumigatus infection and lung inflammation: case report A 68-year-old man developed Aspergillus fumigatus infection and lung inflammation during treatment with durvalumab, carboplatin and paclitaxel for squamous cell carcinoma of the left upper lobe [not all routes, dosages and duration of treatments to reaction onsets stated]. The man, who had a smoking history and squamous cell carcinoma of the left upper lobe, was hospitalised for chemoradiotherapy. The chemoradiotherapy was initiated with carboplatin area under curve-4 and paclitaxel [nanoparticle albumin-bound paclitaxel] 100 mg/m2 on days 1, 15 and 29. A significant improvement was noted following completion of the chemoradiotherapy. Thereafter, he received first dose of durvalumab 10 mg/kg every two weeks and was discharged. He again presented after 9 days of the second dose of durvalumab. Lung infiltrate in the left upper lobe outside the radiation field were noted on CT scan. A bacterial pneumonia or immune-related event was suspected, and he was again hospitalised. The man was treated with prednisolone and ceftriaxone. A CT scan performed after 14 days of the re-admission showed cavitary lesion. Bronchoscopy was performed, and Aspergillus fumigatus was detected in the specimen. It was concluded that the immunosuppressive action of carboplatin and paclitaxel followed by enhanced inflammatory response of durvalumab led to Aspergillus fumigatus infection and uncontrollable lung inflammation. He was treated with voriconazole and amphotericin-B liposomal. His fever persisted, and further development of the cavitary lesion was noted on CT scan. His entire left lung was destroyed along with worsening of his general condition. He then underwent a left pneumonectomy on day 88 of re-admission. A scarred nodule at the site of the primary tumour with granulation tissue around was noted in pathology of the removed lung. Additionally, a cavernous lesion having a necrotic substance inside was observed along with a presence of coagulation necrosis and macrophage infiltration. An organised exudate was noted in the respiratory tract. In the lung tissue, only one colony of Aspergillus was identified. His general condition improved after the surgery. He remained well without any sign of recurrence, one year after the discharge. Taima K, et al. Destroyed lung due to sustained inflammation after chemoradiotherapy followed by durvalumab. Respirology Case Reports 8: No. 5, Jul 2020. Available from: 803519025 URL: http://doi.org/10.1002/rcr2.580

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Reactions 5 Dec 2020 No. 1833