Submitted by: Michael on: 16 April 2013
Case number: 10
A 77 year old man presented with a productive cough, wheezing and weight loss. He gave a history of smoking-related chronic obstructive airways disease and segmentectomy of his left upper lung for squamous cell carcinoma. CT scan of the thorax showed a cavity of 15.9cm2 containing a fungus ball, occupying the left pleural space above his lung. Serological findings for Aspergillus were strongly positive. Itraconazole therapy was started, but discontinued when sputum cultures grew A. fumigatus resistant to itraconazole. He was then given intravenous amphotericin B for 6 weeks. He improved clinically but the radiological appearances remained unchanged. In September 1998, his treatment was changed to itraconazole (400mg/d). No progression of parenchymal disease has been observed since therapy started. The patient remained reasonably well.
Species (if applicable): Aspergillus fumigatus