[Successful treatment of chronic necrotizing pulmonary aspergillosis with oral itraconazole long-term therapy].
METHODS
A 66-year-old man with bullous pulmonary emphysema, was being treated with oral prednisone, had over the previous two month experienced dyspnoea, productive cough and an 8 kg weight loss. Physical examination revealed inspiratory rales over the right middle lobe, with faint vesicular breathing in the other lobes.


METHODS
Inflammation parameters were markedly elevated (WBC 24,800/microliter, C-reactive protein 28.6 mg/dl), while the chest radiograph showed liquid infiltrates in the right upper and middle lobes. Despite administration of antibiotics the infiltrates persisted. Aspergillus fumigatus was demonstrated in bronchial secretion.


METHODS
Antifungal treatment with itraconazole (400 mg/d) was started and resulted in marked subjective improvement, normalization of the inflammation parameters and slow regression of the pulmonary infiltrates. Thoracic computed tomography one year later merely revealed residual post-inflammatory changes.


CONCLUSIONS
An insidious course and treatment-resistant lung infiltrates in patients with steroid treatment should suggest chronic necrotizing pulmonary aspergillosis and this pathogen should be looked for in bronchial secretions. Antifungal treatment with itraconazole is essential and efficacious.
Tasci
S
S
Medizinische Universitäts- und Poliklinik II, Rheinische Friedrich-Wilhelms-Universität Bonn. seltasci@mailer.meb.uni-bonn.de
Schäfer
H
H
Ewig
S
S
Layer
G
G
Gillissen
A
A
D000284:Administration, Oral; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001228:Aspergillosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001232:Aspergillus fumigatus / Q000187:drug effects; D002908:Chronic Disease; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage* / Q000009:adverse effects; D008134:Long-Term Care; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D014057:Tomography, X-Ray Computed
D000935:Antifungal Agents; D017964:Itraconazole