title: Successful treatment of refractory chronic necrotizing pulmonary aspergillosis with micafungin.
abstract: A 63-year-old man was admitted to our hospital because he complained of fever and productive cough; this was associated with cavitary infiltrates on his chest X-ray. Although several antibiotics were given, his symptoms did not improve. Bronchofiberscope investigation yielded Aspergillus fumigatus; thus, he was diagnosed with chronic necrotizing pulmonary aspergillosis. Itraconazole, 200 mg/day, was given, and his symptoms and infiltrates on chest X-ray gradually improved. After 2 months of treatment, new infiltrates appeared on a chest X-ray. Antibacterial agents had also shown no effect, and voriconazole was substituted for itraconazole. However, the infiltrates progressed in spite of the voriconazole administration. We added micafungin to the voriconazole treatment. Both his symptoms and the infiltrates on chest X-rays improved. Because voriconazole is thought to be the most effective agent against Aspergillus spp., it is difficult to treat cases that are refractory to voriconazole. The treatment of this case provides invaluable information on how to treat pulmonary aspergillosis related to diseases other than hematologic malignancies.
authors.affiliation: Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ouchi
authors.forename: Masaki
authors.initials: M
authors.lastname: Fujita
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ikegame
authors.forename: Ichiro
authors.initials: I
authors.lastname: Inoshima
authors.forename: Eiji
authors.initials: E
authors.lastname: Harada
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Nakanishi
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D001232:Aspergillus fumigatus / Q000187:drug effects*; D002908:Chronic Disease; D026141:Drug Resistance, Multiple, Fungal / Q000187:drug effects; D054714:Echinocandins / Q000627:therapeutic use*; D006801:Humans; D055666:Lipopeptides; D008074:Lipoproteins / Q000627:therapeutic use*; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D009336:Necrosis; D011743:Pyrimidines / Q000627:therapeutic use; D011859:Radiography; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008074:Lipoproteins; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole; D000077551:Micafungin