[Two cases of invasive pulmonary aspergillosis mimicking pneumonia in lung cancer patients].
BACKGROUND
Invasive pulmonary aspergillosis (IPA) occurs predominantly in immunocompromised hosts, however increasing numbers of cases of IPA have been reported among basically immunocompetent patients who have some pulmonary abnormalities such as lung cancer and chronic obstructive pulmonary disease (COPD).


METHODS
Case 1. A 67-year-old man was admitted because of hemoptysis and purpura. He had COPD and small cell lung cancer and had finished chemotherapy 5 years previously. Chest X-ray showed pneumonia-like infiltration in his right lower lung field, and marked thrombocytopenia was pointed out. We started antibiotics and corticosteroids for community-acquired pneumonia (CAP) and idiopathic thrombocytopenic purpura. During treatment, we found Aspergillus fumigatus in his sputum culture and therefore added antifungal agents to his treatment. Despite intensive care, he died due to multi-organ dysfunction. Case 2. An 80-year-old man was admitted with fever and productive cough. He had COPD and non-small cell lung cancer and finished chemotherapy 2 months previously. Chest X-ray showed pneumonia-like infiltration in his right upper lung field. We started antibiotics and corticosteroids for acute exacerbation of COPD because of CAP. Several weeks later, after we observed initial improvement of his condition, pneumonia-like infiltration re-developed and Aspergillus fumigatus was detected in his sputum. We started antifungal agents and the treatment of IPA was successful, but he died because of idiopathic perforation of the sigmoid colon.


CONCLUSIONS
In patients without myelosuppression, IPA could develop pneumonia-like pulmonary infiltrations.
Horinouchi
Hidehito
H
Division of Pulmonary Medicine, St. Luke's International Hospital.
Yamao
Sayaka
S
Gotoh
Shimpei
S
Jinta
Torahiko
T
Nishimura
Naoki
N
Suzuki
Koyu
K
Chohnabayashi
Naohiko
N
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications*; D017714:Community-Acquired Infections; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D016867:Immunocompromised Host; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D018410:Pneumonia, Bacterial; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D013902:Radiography, Thoracic; D055752:Small Cell Lung Carcinoma / Q000150:complications*; D014057:Tomography, X-Ray Computed
D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents