Combined Effect of Micafangin and Itraconazole on Severe Aspergillosis of the Bilateral Pleural Cavities in a Patient with Wegener's Granulomatosis

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  • Endo Hirahito
    Department of Internal Medicine, Kitasato University School of Medicine
  • Yoshida Hide
    Department of Internal Medicine, Kitasato University School of Medicine
  • Kondo Hirobumi
    Department of Internal Medicine, Kitasato University School of Medicine
  • Kume Hikaru
    Department of Pathology, Kitasato University School of Medicine
  • Nomura Tomokiyo
    Department of Thoracic Surgery, International Medical Center of Japan

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Other Title
  • 両側の肺空洞病変にアスペルギルス感染を合併し抗真菌薬，ミカファンギンとイトラコナゾールの併用療法が有効であったＷｅｇｅｎｅｒ肉芽腫症の一例
  • リョウガワ ノ ハイ クウドウ ビョウヘン ニ アスペルギルス カンセン オ ガッペイ シ コウシンキンヤク,ミカファンギン ト イトラコナゾール ノ ヘイヨウ リョウホウ ガ ユウコウ デ アッタ Wegener ニクガ シュショウ ノ イチレイ

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Visceral fungal infections are difficult to manage in patients with collagen diseases and immunocompromised hosts. In particular aspergillosis can be a life-threatening complication in these patients. Here we report that combined use of two antifungal agents (micafangin and itraconazole) was effective against severe aspergillosis of the bilateral pleural cavities in a 48-year old male patient diagnosed with Wegener's granulomatosis. Immunosuppressive therapy with corticosteroids and cyclophosphamides improved his nasal and pulmonary symptoms, but inflammation of the bilateral pleural cavities caused bronchial fistulas. Aspergillus fumigatus then infected the bilateral pulmonary cavities through these fistulas. This patient was treated with combined therapy of ITCZ and MCFG was given to this patient because of the risk of renal dysfunction associated with AMPH-B. After 5 weeks of treatment his clinical findings had improved and the fungus was suppressed.

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