Submitted by: Michael on: 16 April 2013
Case number: 9
A 46 year old social worker had a history of restrictive lung disease (type
1). In the past, she had a history that dates back to her childhood with multiple chest infections and, at the age of 18 two simple pneumothoraces and subsequently an open pleurodesis. She remained well up until 1993 with several small simple cysts at the apex of the right lung. In late 1993, she developed a constant cough and generally felt unwell. She lost weight and suffered increasing fatigue. Aspergillosis was diagnosed, new cavity formation in the upper lobe of the right lung and growth of A. fumigatus from bronchoalveolar lavage fluid and sputum on several occasions. This patient had a mannose binding deficiency.
In February 1999 she was admitted to hospital with a chest infection and production of green sputum, which had not improved with antibiotics.
Examination revealed an emaciated patient with bronchial breathing in the upper zone of the right lung. A. fumigatus was the sole pathogen cultured from sputum. Itraconazole therapy was commenced. After 6 weeks therapy she was worse and
amphotericin B was given for 12 weeks. During the following 2 months the patient began to improve and she started to gain weight.
Species (if applicable): Aspergillus fumigatus