046. Unusual pulmonary infection in a patient treated with a1-proteinase inhibitor

Background: Description of clinical worsening and radiological image characteristics in a patient under chronic treatment with a1-proteinase inhibitor (prolastine).

Case report: We present a case of 47 years old woman, ex-smoker (30 p/y) with pulmonary emphysema. She has been under treatment with a1-proteinase inhibitor—once per month intravenous, for a six months period. She was admitted to our hospital because of persistent febrile and hypoxic deterioration of her already known chronic respiratory failure. Blood tests were revealed elevated inflammatory markers (WBC, CRP). Radiological investigation (Rx and CT) revealed: (I) consolidation with many small sized cavitations in the right upper lobe lesion; (II) ground glass opacification in the same lobe and (III) consolidation without cavitations in the left lower lobe. The patient was further investigated bronchoscopically. The culture of bronchial washing yielded no positive result for common microbes, mycobacteria or fungi. The cytological examination of bronchial lavage was negative for malignancy but in the same specimen rare fungal hyphae were identified. Blood and sputum cultures were also negative. She was administered moxifloxacin and piperacillin/tazobactam but she remained febrile and then she was given linezolid and voriconazole but again without response. The fever waves resolved automatically within ten days. Respiratory function improved gradually, and radiographic findings resolved after a month.

Conclusions: Chronic treatment with prolastin predispose to the occurrence of viral respiratory infections—mainly the type of Parvovirus. The radiographic image shows simultaneous infiltrates in different lobes that vary from ground glass opacification to consolidation with or without cavitary lesions.

Keywords: A1-antitrypsin deficiency; infection; bacteria