Clinical features of chronic pulmonary aspergillosis in patients with interstitial pneumonia

Shigeo Hanada, Hironori Uruga, Hisashi Takaya, Atsushi Miyamoto, Hideyasu Sugimoto, Nasa Morokawa, Atsuko Korosaki, Takeshi Fujii, Kazuma Kishi.

Author address: 

1Department of Respiratory Medicine, Toranomon Hospital, Tokyo, Japan 2Department of Diagnostic Radiology, Toranomon Hospital, Tokyo, Japan 3Department of Pathology, Toranomon Hospital, Tokyo, Japan

Abstract: 

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.
2010

abstract No: 

P2914

Full conference title: 

20th European Respiratory Society conference
    • ERS 20th (2010)