Two Cases of Pulmonary Aspergillosis Successfully Treated with Combinated Micafungin and Itraconazole Therapy

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  • FURUGEN Makoto
    Department of Medicine and Infectious Diseases, Graduate School of Medicine, University of the Ryukyus
  • HARANAGA Shusaku
    Department of Medicine and Infectious Diseases, Graduate School of Medicine, University of the Ryukyus
  • TOUYAMA Masato
    Department of Medicine and Infectious Diseases, Graduate School of Medicine, University of the Ryukyus
  • SHIROMA Runa
    Department of Medicine and Infectious Diseases, Graduate School of Medicine, University of the Ryukyus
  • YARA Satomi
    Department of Medicine and Infectious Diseases, Graduate School of Medicine, University of the Ryukyus
  • SHINZATO Takashi
    Department of Medicine and Infectious Diseases, Graduate School of Medicine, University of the Ryukyus
  • HIGA Futoshi
    Department of Medicine and Infectious Diseases, Graduate School of Medicine, University of the Ryukyus
  • TATEYAMA Masao
    Department of Medicine and Infectious Diseases, Graduate School of Medicine, University of the Ryukyus
  • SAITOU Atsushi
    Japanese Red Cross Nagasaki Genbaku Isahaya Hospital
  • FUJITA Jiro
    Department of Medicine and Infectious Diseases, Graduate School of Medicine, University of the Ryukyus

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Other Title
  • ミカファンギンとイトラコナゾールの併用にて治療した肺アスペルギルス症の2症例
  • ミカファンギン ト イトラコナゾール ノ ヘイヨウ ニテ チリョウ シタ ハイ アスペルギルスショウ ノ 2 ショウレイ

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Abstract

We report 2 cases of pulmonary aspergillosis treated successfully by combining micafungin and traconazole. Case 1: A 51-year-old man with hemoptysis and dyspnea on effort treated for pulmonary tuberculosis and aspergillosis was found on chest CT on admission to have a fungus ball in the left upper lobe and increasing consolidation around the cavity of both lung fields. Bronchoscopy proved positive for aspergillus PCR in bronchial lavage. He was diagnosed with chronic necrotizing pulmonary aspergillosis, based on clinical and radiological findings and the positive reaction for aspergillus PCR. He was treated with micafungin alone at first, this proved ineffective, so itraconazole was added, resulting in improvement. Case 2: A 24-year-old woman with stabilized Hodgkin's disease (mixed). She had suffered from a cough and back pain, and chest CT showed increasing consolidation inside and around a giant bulla. She was diagnosed with chronic necrotizing pulmonary aspergillosis, based on isolation for Aspergillus sp. in sputum culture and a positive reaction for Aspergillus antigen in bronchial lavage and Aspergillus antibody in serum. She was treated with the combined micafungin and itraconazole, which rapidly improved symptoms and radiological findings. Pulmonary aspergillosis therapy is often difficult, because delivery of the drug to the infection site is limited and drug tolerance is poor. We found that combination micafungin and itraconazole therapy is tolerable and effective in these cases.

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 79 (12), 951-956, 2005

    The Japanese Association for Infectious Diseases

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