[Pulmonary aspergillosis complicating chronic septic granulomatosis. Treatment with itraconazole and gamma interferon].
A 20-year-old patient suffering from chronic granulomatous disease developed pulmonary aspergillosis with thoracic wall invasion. Treatment with itraconazole combined with 3-weekly injections of interferon gamma (INF gamma) improved the patient's general state of health within two months. Functional signs resolved totally and x-ray images continued to improve for 6 months. INF gamma was withdrawn after 11 months and was replaced with cotrimoxasole. Itraconazole was continued in a long-term regimen. Four years after onset of treatment, the clinical status of the patient remained satisfactory, and the radiological aspect was unchanged. Pulmonary aspergillosis affects up to 40% of patients suffering from chronic granulomatous disease. Mortality is high, to the order of 25%. The classical treatment is based on amphotericin B, but this case points out the significant contribution of itraconazole as first-line therapy. This antimycotic has been suggested for prophylaxis. The combined use of INF gamma can be discussed due to the uncertainties about its long-term effects and because of the requirement for 3-weekly injections. High cost is another important consideration.
Mulliez
P
P
Service de Pneumologie, Hôpital Saint Philibert, 59462 Lomme.
Jaggi
F
F
Darras
A
A
Demory
J L
JL
Smith
M
M
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006099:Granuloma / Q000150:complications* / Q000382:microbiology; D006801:Humans; D007371:Interferon-gamma / Q000627:therapeutic use*; D017964:Itraconazole / Q000627:therapeutic use*; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D008297:Male; D011379:Prognosis; D018805:Sepsis / Q000150:complications*; D016896:Treatment Outcome
D000935:Antifungal Agents; D017964:Itraconazole; D007371:Interferon-gamma