Two cases of successful treatment of histologically proved chronic necrotizing pulmonary aspergillosis

Ref ID: 19501

Author:

NN Klimko1*, OV Shadrivova1, SN Khostelidi1, RM Chernopyatova1, IS Savosteeva1,
YV Borzova1, SM Ignatyeva1, TS Bogomolova1, NV Vasilyeva1

Author address:

1Clinical Mycology, Allergy and Immunology, I. Mechnikov North-Western State Medical University,
Kashkin Research Insti, St. Petersburg, Russian Federation

Full conference title:

6th Advances Against Aspergillosis 2014

Abstract:

Introduction:
Chronic necrotizing pulmonary aspergillosis (CNPA) usually occurs in patients with chronic lung
diseases (tuberculosis, sarcoidosis, chronic obstructive pulmonary disease (COPD), etc.). The
treatment efficacy of CNPA is not well investigated.
Objective:
We report two cases of successful treatment CNPA in non-immunocompromised patients.
Materials and methods:
Diagnosis criteria included clinical and radiological findings, serological and mycological tests.
Bronchoalveolar lavage (BAL) and sputum samples were examined (direct microscopy and culture
for fungal infection, specific test for M. tuberculosis). The diagnosis CNPA was confirmed by a
histological demonstration of tissue invasion by Aspergillus spp.
Results:
Case 1: A 48-year-old smoker man was admitted to hospital on February 2012 with a 3-month
history of cough, chest pain, fever and weakness. CT-scan results were non-specific and included
air cysts, fibrosis and traction bronchiectasis in the left upper lobe. Aspergillus precipitation test
was positive. Bronchoalveolar lavage (BAL) and sputum cultures (fungal and mycobacterial) were
negative. Diagnostic thoracotomy with biopsy was performed. Tuberculosis and sarcoidosis were
excluded. Histological examination of the biopsy specimens showed septate branching hyphae in
lung tissue and chronic inflammatory process with necrosis areas. The patient was treated with
itraconazole 200 mg bid. After three months of treatment, the patient was asymptomatic with
regression of lesions on CT. Overall duration of itraconazole treatment for 11 months. There was no
relapse in follow up period.
Case 2: A 59-year-old non-smoker man was admitted on May 2012 with long-term cough,
episodically bloody sputum and weakness. He had a medical history of pulmonary tuberculosis
and resection of the right upper lobe on 1977. On 2009 chest CT scan showed at right lung cavities
with a fungus balls. In 2011 CT scans revealed increasing in the number and size of lung cavities.
The IgG for Aspergillus was positive. Right pneumonectomy was performed on September 2012.
Histological examination detected a cavitary lesion with necrotic lung tissue invaded by septate
branching hyphae. The final diagnosis was CNPA and treatment with itraconazole (200 mg bid)
was started for 8 months. In follow-up period the patient’s condition stable, he had insignificantly
reduction of lung function, and normal range of vital capacity. CT signs of the disease were absent.
Conclusion:
Combination of surgical and antifungal therapy needed for successful treatment of chronic necrotizing
pulmonary aspergillosis. Itraconazole may be effective in the treatment of this disease.

Abstract Number: 29

Conference Year: 2014

Link to conference website: http://www.AAA2014.org

New link: NULL

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