title: [Two cases of pulmonary aspergillosis successfully treated with combinated micafungin and itraconazole therapy].
abstract: We report 2 cases of pulmonary aspergillosis treated successfully by combining micafungin and traconazole. Case 1: A 51-year-old man with hemoptysis and dyspnea on effort treated for pulmonary tuberculosis and aspergillosis was found on chest CT on admission to have a fungus ball in the left upper lobe and increasing consolidation around the cavity of both lung fields. Bronchoscopy proved positive for aspergillus PCR in bronchial lavage. He was diagnosed with chronic necrotizing pulmonary aspergillosis, based on clinical and radiological findings and the positive reaction for aspergillus PCR. He was treated with micafungin alone at first, this proved ineffective, so itraconazole was added, resulting in improvement. Case 2: A 24-year-old woman with stabilized Hodgkin's disease (mixed). She had suffered from a cough and back pain, and chest CT showed increasing consolidation inside and around a giant bulla. She was diagnosed with chronic necrotizing pulmonary aspergillosis, based on isolation for Aspergillus sp. in sputum culture and a positive reaction for Aspergillus antigen in bronchial lavage and Aspergillus antibody in serum. She was treated with the combined micafungin and itraconazole, which rapidly improved symptoms and radiological findings. Pulmonary aspergillosis therapy is often difficult, because delivery of the drug to the infection site is limited and drug tolerance is poor. We found that combination micafungin and itraconazole therapy is tolerable and effective in these cases.
authors.affiliation: Department of Medicine and Infectious Diseases, Graduate School of Medicine, University of the Ryukyus.
authors.forename: Makoto
authors.initials: M
authors.lastname: Furugen
authors.forename: Shusaku
authors.initials: S
authors.lastname: Haranaga
authors.forename: Masato
authors.initials: M
authors.lastname: Touyama
authors.forename: Runa
authors.initials: R
authors.lastname: Shiroma
authors.forename: Satomi
authors.initials: S
authors.lastname: Yara
authors.forename: Takashi
authors.initials: T
authors.lastname: Shinzato
authors.forename: Futoshi
authors.initials: F
authors.lastname: Higa
authors.forename: Masao
authors.initials: M
authors.lastname: Tateyama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Saitou
authors.forename: Jiro
authors.initials: J
authors.lastname: Fujita
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage*; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy*; D018893:Bronchoalveolar Lavage; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054714:Echinocandins; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage*; D055666:Lipopeptides; D008074:Lipoproteins / Q000008:administration & dosage*; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008074:Lipoproteins; D010456:Peptides, Cyclic; D017964:Itraconazole; D000077551:Micafungin