Conduite à tenir face au risque d'aspergillose pulmonaire chez un patient atteint de maladie de Wegener

Beside the well-known population at risk for invasive pulmonary aspergillosis (IPA) (bone marrow and solid transplantations), new populations of immunocompromised patients (treated with corticosteroids, cyclophosphamide, and/or biotherapy…) are emerging, for which aspergillosis outcome will be improved with a rapid diagnosis, the administration of antifungal drugs as well as the management of underlying disease. We report herein a case of possible IPA in a patient with Wegener granulomatosis (WG). Aspergillus fumigatus was isolated from BAL, associated with respiratory failure (dyspnea, cough and expectoration in the absence of fever) after initiating current immunosuppressive therapy for extensive WG. The clinical status has been improved under antifungal therapy (voriconazole); the immunosuppressive treatment was also modified cyclophosphamide being replaced with azathioprine. The authors discuss how to manage and treat such aspergillosis risk regarding WG physiopathology, taking into account the immunosuppressive therapy.