Invasive Aspergillosis — SCE Infectious Diseases MCQ

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HardFungal InfectionsInvasive AspergillosisSCE Infectious Diseases

A 62-year-old man with chronic lymphocytic leukaemia on Ibrutinib presents with 2 weeks of fever, cough, and pleuritic chest pain. CT chest shows a wedge-shaped peripheral consolidation with air-crescent sign. Serum galactomannan is 3.2. What is the first-line treatment?

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Correct answer: C — Voriconazole IV loading then oral maintenance

The air-crescent sign indicates recovery-phase invasive aspergillosis (cavitation of the infarcted tissue). Positive galactomannan confirms Aspergillus. Voriconazole remains first-line for invasive aspergillosis per IDSA/ESCMID guidelines. Critically, Ibrutinib is a CYP3A4 substrate and strong inhibitor — Voriconazole will increase Ibrutinib levels significantly. Ibrutinib dose reduction or holding is required with close monitoring. TDM of Voriconazole (trough 1–5.5 mg/L) is essential.

Reference: IDSA 2016 – Aspergillosis guidelines; BSAC 2024 – Antifungal guidelines