[Case of allergic bronchopulmonary aspergillosis successfully treated with itraconazole].
A 58-year-old woman had a productive cough but not from bronchial asthma. A chest radiograph revealed infiltrative shadows in right middlelung field on September, 2004. Aspergillus fumigatus was detected in a sputum culture. She was treated with oral itraconazole. After the treatment, infiltrative shadows on her chest radiograph disappeared. On October 2005, her peripheral blood showed eosinophilla, a high serum level of total immunoglobulin E (IgE), and a chest radiograph revealed new infiltrative shadows in both lung fields. A chest computed tomography revealed multiple nodular shadows and central bronchiectasis. We detected a mucoid plug which showed a large number of eosinophils pathologically by bronchoscopy. Aspergillus niger was detected in a bronchial lavage fluid. We therefore made a diagnosis of allergic bronchopulmonary aspergillosis (ABPA). The decreases of peripheral blood eosinophils and a serum IgE level were recognized and multiple nodular shadows disappeared by reinstitution of itraconazole. However, a chest computed tomography revealed new infiltrative shadows. Therefore, we treated her with the concomitant administration of oral itraconazole and inhaled corticosteroid. All laboratory data and image findings were improved. It is critical to consider the both aspects of allergy and infection in the treatment for ABPA.
Isobe
Zen
Z
Department of Respiratory Medicine, Gunma University Graduate School of Medicine. isobezen@showa.gunma-u.ac.jp
Suga
Tatsuo
T
Hamaguchi
Shigeto
S
Hara
Kenichirou
K
Aoki
Nozomi
N
Aoki
Fumiaki
F
Aoyagi
Kana
K
Ueno
Manabu
M
Maeno
Toshitaka
T
Kurabayashi
Masahiko
M
D000280:Administration, Inhalation; D000730:Androstadienes / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D001234:Aspergillus niger / Q000302:isolation & purification; D004359:Drug Therapy, Combination; D005260:Female; D000068298:Fluticasone; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage*; D008875:Middle Aged; D016896:Treatment Outcome
D000730:Androstadienes; D000935:Antifungal Agents; D017964:Itraconazole; D000068298:Fluticasone