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Persistent FN with IPA — RACP Adult Medicine MCQ

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HardInfectious DiseasesPersistent FN with IPARACP Adult Medicine

A neutropenic patient remains febrile after five days of broad-spectrum antibacterial therapy. CT shows new pulmonary nodules with halo signs and serum galactomannan is positive. Which treatment should be added?

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Correct answer: B — Start mould-active therapy such as voriconazole, with isavuconazole or liposomal amphotericin selected for patient factors

The best answer is “Start mould-active therapy such as voriconazole, with isavuconazole or liposomal amphotericin selected for patient factors”. The clinical, imaging and biomarker pattern strongly supports invasive pulmonary aspergillosis. Voriconazole is a standard first-line agent, while isavuconazole or liposomal amphotericin may be preferred for interactions, organ function or prior azole exposure. Fluconazole and nystatin lack mould activity, and delaying treatment in prolonged neutropenia increases mortality.

Reference: eviQ: Antifungal prophylaxis in immunocompromised adults: https://www.eviq.org.au/clinical-resources/side-effect-and-toxicity-management/prophylaxis-and-treatment/1604-antifungal-prophylaxis-in-immunocompromised-a