Submitted by: Michael on: 15 April 2013
Case number: 5
This woman of 20 years was born with a severe kyphoscoliosis deformity (corrected with Harrington rods) and secondary to this was troubled with severe chest infections that required multiple courses of antibiotic therapy over many years. She also has exocrine pancreatic deficiency. In March 1992, a chest x-ray revealed cystic changes in her left lower lobe. In September 1995 a fresh infiltrate appeared in the same region which rapidly progressed into a cavity. Under CT guidance, fluid was aspirated and culture grew A. fumigatus. Intracavitary amphotericin B (50mg daily) and oral itraconazole (200mgbd) were given for a period of a few weeks, then they were stopped because cultures from the cavitary drain revealed Stenotrophomonas maltophilia. Her general condition deteriorated and in February 1998 she underwent a partial left lower lobectomy and thoracoplasty. Pathological examination of sections of lung and pleura showed destruction of normal lung architecture.
Species (if applicable): Aspergillus fumigatus