title: [Autopsy case of pulmonary aspergillosis soon after convalescence from pulmonary tuberculosis].
abstract: A 70-year-old man with liver cirrhosis and previous gastrectomy admitted for fever, coughing, and bloody sputum soon after convalescing from pulmonary tuberculosis had a peripheral white blood cell count of 9,900/microL, C-reactive protein of 14.1mg/dL, serum albumin of 2.0g/dL, and serum positive for antiaspergillus and beta-D glucan antibodies. Chest radiography showed thickening of the walls of the large residual cavities with previous tuberculosis lesions and infiltrates around them. On day 2 of hospitalization, Aspergillus fumigatus without other bacillus was detected in sputum culture taken on admission. Despite immediate treatment with intravenous micafungin and oral itraconazole and improved brief initial improvement, his general condition abruptly deteriorated into frequent massive hemoptysis and he developed of shock, respiratory failure, and severe malnutrition, dying 30 days later. Autopsy findings showed pulmonary aspergillosis in and around the large cavities and on the other side of the lungs. Pulmonary aspergillosis without hematological malignanciy and immunosuppression can thus be abruptly severe and fatal due to malnourishment stemming from pre-existing conditions such as chronic hepatitis despite prompt, ordinarily adequate medical treatment.
authors.affiliation: Department of Respiratory Medicine, Tenri Hospital.
authors.forename: Ko
authors.initials: K
authors.lastname: Maniwa
authors.forename: Eisaku
authors.initials: E
authors.lastname: Tanaka
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Inoue
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakuramoto
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Minakuchi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Maeda
authors.forename: Kiminobu
authors.initials: K
authors.lastname: Tanizawa
authors.forename: Tomoshi
authors.initials: T
authors.lastname: Takeda
authors.forename: Masaki
authors.initials: M
authors.lastname: Okamoto
authors.forename: Masaru
authors.initials: M
authors.lastname: Komatsu
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Taguchi
mesh_terms: D000368:Aged; D001228:Aspergillosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D017809:Fatal Outcome; D006801:Humans; D008168:Lung / Q000382:microbiology* / Q000473:pathology; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D008297:Male; D011859:Radiography; D014397:Tuberculosis, Pulmonary / Q000150:complications*