Chronic necrotizing pulmonary aspergillosis as a complication of pulmonary Mycobacterium avium complex disease.
OBJECTIVE
To investigate the characteristic clinical features of chronic necrotizing pulmonary aspergillosis (CNPA) as a complication of pulmonary Mycobacterium avium complex (MAC) disease.


METHODS
Clinical analysis of nine cases without a history of old pulmonary tuberculosis in whom CNPA was found to be a complication during the follow-up period for MAC disease.


RESULTS
The average duration from the diagnosis of pulmonary MAC disease to the diagnosis of CNPA was 36.0 months. Five patients received antituberculous therapy including clarithromycin for pulmonary MAC disease, but this treatment was ineffective in most. A positive culture for Aspergillus spp. from sputum and a bronchoscopic specimen and clinical evidence of a chronic infective process were recognized in all cases at the time of detection of CNPA. Serological fungal examinations for anti-Aspergillus IgG antibody were initially negative and became positive in all cases during the follow-up period of pulmonary MAC disease. The presence of CNPA surrounding the cavity previously caused by MAC was characterized by local thickening of the cavity with a fungus ball and the appearance of an infiltration shadow surrounding the cavity. In most of the cases, CNPA was at first treated with oral itriconazole and then with i.v. infusion of micafungin, but the clinical efficacy was generally poor.


CONCLUSIONS
The results of this study showed that during the long follow-up period of patients with pulmonary MAC disease it is important to not only carry out serological examinations, but also perform radiological examinations using chest CT.
Kobashi
Yoshihiro
Y
Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Kurashiki, Japan. yoshihiro@med.kawasaki-m.ac.jp
Fukuda
Minoru
M
Yoshida
Kouichiro
K
Miyashita
Naoyuki
N
Niki
Yoshihito
Y
Oka
Mikio
M
D000368:Aged; D001228:Aspergillosis / Q000097:blood / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D001232:Aspergillus fumigatus / Q000276:immunology; D001234:Aspergillus niger / Q000276:immunology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008172:Lung Diseases, Fungal / Q000097:blood / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D008297:Male; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications* / Q000473:pathology; D009336:Necrosis / Q000473:pathology; D011446:Prospective Studies; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000473:pathology
D007074:Immunoglobulin G