Abstract
A 49-year-old man with a history of left upper lung lobectomy for pulmonary asperigilloma developed a productive cough in the middle of April 1992, and his chest X-ray film showed infiltration of the left S6. Treatment with several different antibiotics was tried, but the shadow expanded and developed a cavity over the following 8 months. A clinical diagnosis of chronic necrotizing pulmonary aspergillosis was made, based on repeated detection of Aspergillus fumigatus in the patient's sputum and in specimens obtained by fiberoptic branchoscopy and percuraneous needle biopsy. Prior lobectomy and a marked idiopathic decrease in ventilation and perfusion in the affected lung are risk factors for this disease. Slow intravenous infusion of amphotericin B eradicated the fungus without any side effects. Measurement of drug concentrations during treatment revealed that the concentration in the sputum was far higher than that in the serum, and was also far higher than the minimum inhibitory concentration for the fungus.
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