Reporting a Case with Literature Review: Sunitinib Use for Metastatic Renal Cell Carcinoma Associated with Necrotizing Cavitary Pulmonary Aspergillosis with Aspergillus Flavus

Chronic necrotizing cavitary pulmonary aspergillosis caused by sunitinib is a rare occurrence in the literature. The patient in this case had biopsy-proven papillary renal cell carcinoma, which was treated with radical nephrectomy at first. He presented with progressively worsening abdominal pain, headaches, and a 40-pound weight loss eight months later, and investigation revealed extensive retroperitoneal and mediastinal lymphadenopathy with brain metastasis. He was evaluated by oncology and started on sunitinib and dexamethasone cycles, which he continued for about 6 months. His respiratory failure necessitated intubation and ICU admission, and a CT scan of his thorax showed a new large consolidation of necrosis and a cavity. With sunitinib, he was started on empiric Vancomycin, Zosyn, and Voriconazole due to a presumption of opportunistic fungal infection. Aspergillus flavus was discovered after bronchoscopy, bronchoalveolar lavage, and cultures. Galactomannan levels in serum and BAL (Bronchoalveolar Lavage) were later found to be positive. The patient’s family preferred relaxation steps due to the patient’s bad prognosis. Enhanced clinical monitoring and the introduction of risk-based prophylactic strategies will help in the prevention, early detection, and management of these infections.

Author (s) Details

Suganthini Krishnan Natesan
John D. Dingell VA Medical Center, Wayne State University, Detroit, MI, USA.

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