Kronik nekrotizan pulmoner aspergillozis genellikle var olan akciğer hastalığı veya immun sistem bozukluğu nedeniyle meydana gelen lokal savunma bozukluğu olan hastalarda görülen subakut bir enfeksiyondur. Altmış bir yaşında KOAH tanısı olan erkek hasta siyanoz, ilerleyici dispne ve balgam çıkarma yakınması ile başvurdu. İki hafta süreli geniş spektrumlu antibiotik, bronkodilatatör ve steroid tedaviye rağmen semptomları ilerledi. Göğüs radyografisi ve BT'de sol alt lob superior segmentte infiltrasyon görüldü. 1 ay içinde klinik durumu bozuldu ve aynı dönemde çekilen BT'de sol alt lobda miçetoma içeren kavite ve plevral efüzyon görüld ü. Bronşial lavaj ve balgam kültüründe Aspergillus sp. üredi ve malignite saptanmadı. Başlanan Amfoterisin B lipid kompleks tedavisi ile tedaviden 1 ay sonra klinik ve radyolojik bulgularda düzelme saptandı. Tedaviye İtrakonazol ile devam edildi, başlangıç semptomları geriledi ve radyografik düzelme devam etti. Olgumuzu erken tanınıp tedavi edilmiş olması ve tedavinin başarılı olması nedeniyle literatür eşliğinde sunduk.
1. Dokuzo¤uz B. HIV/AIDS ve f›rsatç› infeksiyonlar.
Uzun Ö, Ünal S (ed). Güncel bilgiler ›fl›¤›nda
infeksiyon hastal›klar›. Ankara: Bilimsel T›p
Yay›nevi 2002; 969-82.
2. Sugar MA, Olek EA. Aspergillus syndromes,
mucormycosis and pulmonary candidiasis.
In: Fishman PA(ed). Pulmonary diseases and
disorders. New York. Mc Graw-Hill Com. 1998:
2266-87.
4. Tabak L. Akci¤erin fungal infeksiyonlar›, Nokardiyoz,
Aktinomikoz. Arseven O(ed). Akci¤er
Hastal›klar›. ‹stanbul, Nobel T›p Kitabevi 2002:
263-72.
5. Hafeez I, Muers MF, Murphy SA, Evans EGV,
Barton RC, McWhinney P. Non-tuberculous
mycobacterial lung infection complicated by
chronic necrotising pulmonary aspergillosis.
Thorax 2000; 55: 717-9.
6. Filippou N, Papachristou K, Ilias I, Pefanis A,
et al. Case report. Chronic necrotizing
pulmonary aspergillosis in non-neutropenic
patient treated with liposomal ambhotericin
B. Mycoses 2000; 43(7-8): 313-5.
7. Caras WE, Pluss JL. Chronic necrotizing pulmonary
aspergillosis: pathologic outcome after
itraconazole therapy. Mayo Clin Proc 1996;
71: 25-30.
9. Eliot JA, Milne LJR, Cumming D. Chronic
necrotizing pulmonary aspergillosis treated
with itraconazole. Thorax 1989; 44: 820-1.
10. Franquet T, Müller NL, Gimenez A, Domingo P,
et al. Semiinvasive pulmonary aspergillosis
in chronic obstructive pulmonary disease.
AJR 2000; 174: 51-6.
11. Klein NC, Cunha BA. New antifungal drugs for
pulmonary mycoses. Chest 1996; 110: 525-32.
12. Wong PC, Fung SL, Lee J, Wong CF, et al.
Chronic necrotizing pulmonary aspergillosis.
A report of 9 cases with analysis of clinical
picture, risk factors and treatment for outcome
correlation. Monaldi Arch Chest Dis 2001;
56(3): 202-7
SUBACUTE NECROTIZING PULMONARY ASPERGILLOSIS: CASE REPORT
Year 2004,
Volume: 18 Issue: 2, 83 - 88, 01.10.2004
Chronic necrotizing pulmonary aspergillozis is a subacute infection most commonly seen in patients with altered local defense due to preexisting pulmonary disease or in patients with risk factors that alter systemic immune status. A sixtyone-year-old male patient diagnosed with COPD presented cyanosis, worsening dyspnea and sputum production. Despite two weeks of broad-spectrum antibiotic, bronchodilatator and steroid therapy, his symptoms progressed. His chest radiograph and CT scan revealed an infiltration at superior segment of left lower lobe (LLL). In 1 month, his clinical condition deteriorated and subsequent CT scan showed cavitiy in LLL with mycetoma and pleural effusion. Aspergillus sp. grew in bronchial washing and sputum cultures and cytology revealed no malignancy. After 1 months of treatment with amphoterisin B lipid complex (ABLC), clinic and radiographic findings improved significantly. Therapy continued with itraconazole, during 3 months and his initial symptoms resolved and radiographic improvement is continued. We report this case as he was early diagnosed and treated successfully by reviewing the literature.
1. Dokuzo¤uz B. HIV/AIDS ve f›rsatç› infeksiyonlar.
Uzun Ö, Ünal S (ed). Güncel bilgiler ›fl›¤›nda
infeksiyon hastal›klar›. Ankara: Bilimsel T›p
Yay›nevi 2002; 969-82.
2. Sugar MA, Olek EA. Aspergillus syndromes,
mucormycosis and pulmonary candidiasis.
In: Fishman PA(ed). Pulmonary diseases and
disorders. New York. Mc Graw-Hill Com. 1998:
2266-87.
4. Tabak L. Akci¤erin fungal infeksiyonlar›, Nokardiyoz,
Aktinomikoz. Arseven O(ed). Akci¤er
Hastal›klar›. ‹stanbul, Nobel T›p Kitabevi 2002:
263-72.
5. Hafeez I, Muers MF, Murphy SA, Evans EGV,
Barton RC, McWhinney P. Non-tuberculous
mycobacterial lung infection complicated by
chronic necrotising pulmonary aspergillosis.
Thorax 2000; 55: 717-9.
6. Filippou N, Papachristou K, Ilias I, Pefanis A,
et al. Case report. Chronic necrotizing
pulmonary aspergillosis in non-neutropenic
patient treated with liposomal ambhotericin
B. Mycoses 2000; 43(7-8): 313-5.
7. Caras WE, Pluss JL. Chronic necrotizing pulmonary
aspergillosis: pathologic outcome after
itraconazole therapy. Mayo Clin Proc 1996;
71: 25-30.
9. Eliot JA, Milne LJR, Cumming D. Chronic
necrotizing pulmonary aspergillosis treated
with itraconazole. Thorax 1989; 44: 820-1.
10. Franquet T, Müller NL, Gimenez A, Domingo P,
et al. Semiinvasive pulmonary aspergillosis
in chronic obstructive pulmonary disease.
AJR 2000; 174: 51-6.
11. Klein NC, Cunha BA. New antifungal drugs for
pulmonary mycoses. Chest 1996; 110: 525-32.
12. Wong PC, Fung SL, Lee J, Wong CF, et al.
Chronic necrotizing pulmonary aspergillosis.
A report of 9 cases with analysis of clinical
picture, risk factors and treatment for outcome
correlation. Monaldi Arch Chest Dis 2001;
56(3): 202-7