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FANG FANG, HIDEAKI UI, KAZURO SHIOMI, ROKURO MASUMA, YUUICHI YAMAGUCHI, CHENG GANG ZHANG, XIAN WU ZHANG, YOSHITAKE TANAKA, SATOSHI OMURA, Two New Components of the Aspochalasins Produced by Aspergillm sp., The Journal of Antibiotics, 1997, Volume 50, Issue 11, Pages 919-925, Released on J-STAGE November 25, 2006, Online ISSN 1881-1469, Print ISSN 0021-8820, https://doi.org/10.7164/antibiotics.50.919, https://www.jstage.jst.go.jp/article/antibiotics1968/50/11/50_11_919/_article/-char/en
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Structure of aspochalasin G
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Macroscopic view medial aspect of left upper lobe of lung showing segmental collapse and congestion of lower segments, with mucus extruding from incised bronchi.
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Born 75 years ago, Pt HK had 3 episodes of tuberculosis as a child and teenager, being treated with PAS and streptomycin. He suffered a ‘bad chest’ all his life and retired aged 54. Presenting with worsening and more frequent chest infections, he was referred with ‘bronchiectasis and Aspergillus sensitisation’. A diagnosis of chronic pulmonary aspergillosis was made in June 2009 on the basis of his chest radiograph and strongly positive Aspergillus precipitins (IgG antibodies) (titre 1/16). He also had Pseudomonas aeruginosa colonisation. His oxygen saturation was 87% and his pO2 6.8, pCO2 6.2 KPa.
His chest radiograph (see above, November 2009) was reported as showing; “ The lung fields are over-inflated. Bilateral apical fibrotic change secondary to old TB. No cavity seen.” At clinic, bilateral apical cavities were seen, with some associated pleural thickening at the left apex, without any evidence of a fungal ball.
He started posaconazole 400mg twice daily with therapeutic levels at subsequent visits. Sputum cultures never grew Aspergillus. Over the following 9 months he had no chest infections requiring antibiotics, his breathlessness worsened gradually and he remained easily fatigued. His Aspergillus antibody titres fell. Overall he felt better, but was concerned about declining respiratory status.
