Rare Infant Case of Pulmonary Aspergilloma Highlighting Common Challenges With Voriconazole Dosing

Pediatr Infect Dis J. 2021 Mar 1;40(3):227-230. doi: 10.1097/INF.0000000000002959.


We describe a 6-week-old male-term infant with a pulmonary aspergilloma diagnosed following lobectomy for suspected pleuropulmonary blastoma, with characteristic histopathologic findings and Aspergillus detected by polymerase chain reaction. Intensive testing did not reveal primary or secondary immunodeficiency. During 5 weeks treatment with voriconazole including regular therapeutic drug monitoring and dose adjustment, a level in the target range was never achieved. When the patient developed photosensitivity, treatment was stopped without relapse over 12 months follow-up. Voriconazole dosing is notoriously challenging in children. We review the cumulative published experience with voriconazole use in infants to highlight even greater difficulty in infants. Pulmonary aspergillosis is typically a disease affecting immunocompromised or critically ill patients. In children, it is well described in those with chronic granulomatous disease (CGD) as a complication of immunosuppressive antineoplastic chemotherapy and rarely in extremely- or very-low birthweight premature neonatal intensive care patients. The diagnosis is extremely rare in children without underlying risk factors. To our knowledge, this is the first report of a pulmonary aspergilloma in an immunocompetent infant.

Publication types

  • Case Reports

MeSH terms

  • Antifungal Agents / administration & dosage*
  • Antifungal Agents / adverse effects
  • Antifungal Agents / blood
  • Antifungal Agents / therapeutic use*
  • Aspergillosis / drug therapy*
  • Aspergillus / isolation & purification*
  • Dose-Response Relationship, Drug
  • Drug Monitoring
  • Humans
  • Infant
  • Male
  • Photosensitivity Disorders / chemically induced
  • Voriconazole / administration & dosage*
  • Voriconazole / adverse effects
  • Voriconazole / blood
  • Voriconazole / therapeutic use*


  • Antifungal Agents
  • Voriconazole