Management of semi-invasive aspergillosis and Aspergillus empyema with combination of systemic antifungals and intrapleural amphotericin B in an immunocompetent patient

Y. Tezer, O. Memikoglu, H. Kur

Author address: 

Ankara, TR

Abstract: 

The spectrum of pulmonary aspergillosis varies, ranging from allergic bronchopulmonary aspergillosis to invasive diseases depending on the immune status of the patient and the underlying lung condition. Pleural invasion by Aspergillus species occurs commonly as a late complication of thoracoplasty with bronchopleural fistula. Rarely the rupture of cavitary aspergillosis into the pleural space can produce Aspergillus empyema. Case report: A 39-year old man referred to tertiary hospital, with a history of destroyed left lung and Aspergillus fungus ball for a thoracotomy in thorax surgery department. He had no known medical problems or smoking history. He suffered from cough, hemptysis and weight loss for a month. He had been operated for fungus ball. But after a week fever and leukocytosis were predominant. Chest tube continually drained purulent fluid and air, indicative of bronchopleural fistula. Control thorax computarized tomography had been confirmed that. Pleural fluid specimens examined biochemically, microscopically and cultured for bacteria, mycobacteria and fungi. In exudative fluid Aspergillus fumigatus was grown. Then caspofungin theraphy was started. After 14 days, due to culture positivity and allergic reactions we changed to the liposomal Amphotericin B. After 14 days, purulant fluid discharge were continue. On cultures Aspergillus fumigatus were grown. Then we combined systemic amfhotericin B with caspofungin. But purulant fluid discharge had not been diminished. So we decided to attempt intrapleural antifungal treatment and systemic antifungals together. As described in literature, liposomal amphotericin B was given intrapleurally. During theraphy there were no complications occur. After 3 weeks his fever and leukocyte were in normal range and his galactomannan and CRP leve ls were dropped. His chest tube drainage was diminished but not stopped in 66th day. So he required radical surgery with thoracostomy. Then we continued the treatment with oral voriconazole up to 6 months. Result: After 1 year of follow-up, the patient is well. In our experience we were able to control clinic progress of disease when considered fever and status of the patient by using intrapleural amphotericin B and combined systemic antifungals. But we were unable to control aspergillosis totally. Conclusion: A successful management with remarkable clinical improvement was achieved by pleural drainage, combined antifungal treatment and surgical approach.
2006

abstract No: 

P1198

Full conference title: 

16th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 16th (2006)