Aspergiloma pulmonar secundaria a neutropenia inducida por metimazol: reporte de un caso

Miguel E. Pinto; Claudia Banda; Carlos Seas

doi:10.17843/rpmesp.2012.292.351

Authors

Miguel E. Pinto Servicio de Endocrinología, Hospital Nacional Cayetano Heredia. Lima, Perú. Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia. Lima, Perú. Médico endocrinólogo.
Claudia Banda Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia. Lima, Perú. Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia. Lima, Perú. médico cirujano.
Carlos Seas Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia. Lima, Perú. Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia. Lima, Perú. médico infectólogo.

DOI:

https://doi.org/10.17843/rpmesp.2012.292.351

Keywords:

Aspergillus, Pulmonary aspergillosis, Neutropenia, Methimazole, Antithyroid agents

Abstract

A 48-year old woman with a recent diagnosis of Graves’ disease arrived at the emergency room with fever, palpitations, and a sore throat. Her regular treatment included methimazole. On admission, laboratory results showed suppressed TSH, elevated free thyroxine, and neutropenia. She was admitted and started on antibiotics and granulocyte-macrophage colony stimulating factor (gm-csf). After ten days, the patient developed leukocytosis, fever, and hemoptysis. Chest CT scan showed a lung cavity with multiple nodules in the upper right lobe. Cultures from a lung biopsy were positive for Aspergillus Fumigatus and Aspergillus Flavus. Amphotericin B was started but then switched to voriconazole, with both treatments failing to result in clinical improvement. The patient died of multi-organ failure.