Objective: To evaluate clinical features of chronic pulmonary aspergillosis(CPA) in patients with interstitial pneumonia. Methods: We studied 25 patients with interstitial pneumonia who presented at Toranomon Hospital and developed CPA from January 2005 to December 2009. Results: There were 19 men and 6 women with a mean age of 67 years (range: 26-86). The underlying diseases were idiopathic pulmonary fibrosis (IPF) in 10 patients, idiopathic interstitial pneumonia other than IPF in 3 patients, and interstitial pneumonia related to collagen vascular disease in 12 patients. At the time of CPA diagnosis, all except 2 patients received corticosteroids and/or immunosuppressant therapy. Serum galactomannan antigen and the Aspergillus antibody were positive in 9 of 24 patients (37.5%), and 8 of 13 (61.5%), respectively. Beta-D-glucan level was elevated in 8 of 25 patients (32%). CPA was predominantly presented in the upper lobes (67%) compared to the lower lobes (33%). Computed tomography scan commonly showed cavity (80%), consolidation (80%), and pleural thickening. The diagnosis of definite aspergillosis was made by sputum (n=17), CT-guided needle aspiration biopsy (n=4), fiberoptic bronchoscopy (n=2), video-assisted thoracoscopy surgery (n=1). All patients received antifungal agents. Clinical and/or radiological improvement was obtained in 14 patients (56%). Eight patients (32%) died, 4 of whom died from acute exacerbation of interstitial pneumonia and pneumothorax, 2 from respiratory failure, and 2 from pneumonia and septic shock. Conclusion: CPA is a potentially fatal complication that should be identified and treated early to achieve a better outcome in patients with interstitial pneumonia.
Full conference title:
20th European Respiratory Society conference
- ERS 20th (2010)