Q J Med 2014; 107:587 doi:10.1093/qjmed/hct227
Advance Access Publication 19 November 2013
Clinical picture Chronic necrotizing pulmonary aspergillosis therapy with voriconazole is the primary drug of choice for CNPA.2 In this patient, voriconazole 200 mg was given intravenously twice daily for a period of 4 weeks. Clinical improvement was evident despite no interval change of radiological figure. Photographs and text from: Chang-Han Lo, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Shih-Wei Wu, Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan. email: [email protected] Conflict of interest: None declared.
References 1. Zmeili OS, Soubani AO. Pulmonary aspergillosis: a clinical update. QJM 2007; 100:317–34. 2. Segal BH. Aspergillosis. N Engl J Med 2009; 360:1870–84.
Figure 1. (a) Computed tomography showed focal cavitation with fluid accumulation and bronchiectasis in the left lower lobe. (b) Fluid culture grew multiple fungal septate hyphae in accordance with aspergillus.
! The Author 2013. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on November 14, 2015
A 66-year-old man, presented with a 3-month history of productive cough associated with poor appetite. He was a non-smoker, with a history of old pulmonary tuberculosis and diabetes mellitus with poor control. Laboratory studies showed a white blood cell count of 12 610/ml with 87.6% netrophils, and C-reactive protein of 14.19 mg/dl. Computed tomography demostrated focal cavitation with fluid accumulation and bronchiectasis in the left lower lobe (Figure 1a). Pig-tail drainage was performed and drainage fluid culture grew multiple fungal septate hyphae consistent with aspergillus (Figure 1b). Chronic necrotizing pulmonary aspergillosis (CNPA) was diagnosed based on clinical spectrum.1 CNPA, also called semi-invasive or subacute invasive aspergillosis, usually affects middle-aged and elderly patients with mildly immunocompromised status, such as diabetes mellitus and alcoholism.1 This entity is rare and usually associated with preexisting structural lung disease such as COPD, previous pulmonary tuberculosis and thoracic surgery.1 Particular risk factors in our case were old cavitary tuberculosis and diabetes mellitus. Antifungal
Advance Access Publication 19 November 2013
Clinical picture Chronic necrotizing pulmonary aspergillosis therapy with voriconazole is the primary drug of choice for CNPA.2 In this patient, voriconazole 200 mg was given intravenously twice daily for a period of 4 weeks. Clinical improvement was evident despite no interval change of radiological figure. Photographs and text from: Chang-Han Lo, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Shih-Wei Wu, Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan. email: [email protected] Conflict of interest: None declared.
References 1. Zmeili OS, Soubani AO. Pulmonary aspergillosis: a clinical update. QJM 2007; 100:317–34. 2. Segal BH. Aspergillosis. N Engl J Med 2009; 360:1870–84.
Figure 1. (a) Computed tomography showed focal cavitation with fluid accumulation and bronchiectasis in the left lower lobe. (b) Fluid culture grew multiple fungal septate hyphae in accordance with aspergillus.
! The Author 2013. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
Downloaded from by guest on November 14, 2015
A 66-year-old man, presented with a 3-month history of productive cough associated with poor appetite. He was a non-smoker, with a history of old pulmonary tuberculosis and diabetes mellitus with poor control. Laboratory studies showed a white blood cell count of 12 610/ml with 87.6% netrophils, and C-reactive protein of 14.19 mg/dl. Computed tomography demostrated focal cavitation with fluid accumulation and bronchiectasis in the left lower lobe (Figure 1a). Pig-tail drainage was performed and drainage fluid culture grew multiple fungal septate hyphae consistent with aspergillus (Figure 1b). Chronic necrotizing pulmonary aspergillosis (CNPA) was diagnosed based on clinical spectrum.1 CNPA, also called semi-invasive or subacute invasive aspergillosis, usually affects middle-aged and elderly patients with mildly immunocompromised status, such as diabetes mellitus and alcoholism.1 This entity is rare and usually associated with preexisting structural lung disease such as COPD, previous pulmonary tuberculosis and thoracic surgery.1 Particular risk factors in our case were old cavitary tuberculosis and diabetes mellitus. Antifungal
