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Invasive Aspergillosis — SCE Infectious Diseases MCQ

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ModerateFungal InfectionsInvasive AspergillosisSCE Infectious Diseases

A 58-year-old man with acute myeloid leukaemia is on day 18 of induction chemotherapy. He has been persistently febrile despite 96 hours of Piperacillin/Tazobactam. His neutrophil count is 0.1 × 10⁹/L. CT chest shows a pulmonary nodule with a halo sign. Serum galactomannan is positive (index 2.8). What is the most likely diagnosis and appropriate first-line treatment?

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Correct answer: A — Invasive aspergillosis; Voriconazole IV

The halo sign on CT (ground-glass opacity surrounding a nodule representing haemorrhagic infarction) in a neutropenic patient with positive serum galactomannan is highly suggestive of invasive pulmonary aspergillosis. IV Voriconazole (6 mg/kg BD day 1, then 4 mg/kg BD) is the first-line treatment. Liposomal Amphotericin B is an alternative if Voriconazole is contraindicated or not tolerated. Voriconazole therapeutic drug monitoring is essential (target trough 1–5.5 mg/L).

Reference: BSAC/NICE 2024 – Invasive aspergillosis; ECIL-6 2017 – Antifungal prophylaxis and treatment in haematology