[Case of bronchocentric granulomatosis that became recognized in the course of allergic bronchopulmonary aspergillosis].
A 56-year-old man with allergic bronchopulmonary aspergillosis (ABPA) was admitted due to the appearance of nodular opacities in the right upper lung field on chest radiography, after discontinuing itraconazole and clarithromycin on the suspicion of possible hepatic adverse effects. Chest CT scans on admission revealed nodular opacities in the right S3 and lingula bronchus, and bilateral bronchiectasis with mucoid impactions. A specimen obtained by transbronchial lung biopsy showed complete replacement of bronchioles by necrotizing granulomatous inflammation, containing the diagnosis of bronchocentric granulomatosis. Treatment with corticosteroids and micafungin sodium resulted in marked resolution of nodular opacities and mucoid impacts. This case suggests that abrupt cessation of antifungal agents and macrolides may provoke acute exacerbation of ABPA and development of bronchocentric granulomatosis.
Aihara
Kensaku
K
Division of Respiratory Medicine, Respiratory Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute.
Ishitoko
Manabu
M
Itotani
Ryo
R
Suzuki
Shinko
S
Matsumoto
Masataka
M
Takemura
Masaya
M
Kagioka
Hitoshi
H
Fukui
Motonari
M
D000935:Antifungal Agents / Q000008:administration & dosage; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications* / Q000188:drug therapy; D001982:Bronchial Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D017291:Clarithromycin / Q000009:adverse effects; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000008:administration & dosage; D006099:Granuloma / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006801:Humans; D017964:Itraconazole / Q000009:adverse effects; D055666:Lipopeptides; D008074:Lipoproteins / Q000008:administration & dosage; D018942:Macrolides / Q000009:adverse effects; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D000077551:Micafungin; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008074:Lipoproteins; D018942:Macrolides; D017964:Itraconazole; D017291:Clarithromycin; D000077551:Micafungin; D008775:Methylprednisolone