Invasive aspergillosis due to azole-resistant Aspergillus fumigatus is difficult to manage. We describe a case of azole-resistant invasive aspergillosis in a female bottlenose dolphin, who failed to respond to voriconazole and posaconazole therapy. As intravenous therapy was precluded, high dose posaconazole was initiated aimed at achieving trough levels exceeding 3 mg/l. Posaconazole serum levels of 3–9.5 mg/l were achieved without significant side-effects. Follow-up bronchoscopy and computed tomography showed complete resolution of the lesions.

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Keywords Antifungal therapy, Aspergillus fumigatus, Azole resistance, Bottlenose dolphin, Posaconazole
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Journal Medical Mycology Case Reports
Bunskoek, P.E, Seyedmousavi, S, Gans, S, van Vierzen, P.B.J. (Peter B.J.), Melchers, W.J, van Elk, C.E, … Verweij, P.E. (2017). Successful treatment of azole-resistant invasive aspergillosis in a bottlenose dolphin with high-dose posaconazole. Medical Mycology Case Reports, 16, 16–19. doi:10.1016/j.mmcr.2017.03.005