[Spontaneous lysis of pulmonary aspergillosis: "Aspergillus destroyed by Actinomyces"]

A 79 years old patient developed a large pulmonary aspergilloma in the cavities of his right upper lobe after postinfarctional pneumonia with local abscess formation. The clinical follow-up was characterized by recurrent hemoptysis resulting in marked anemia as well as by a continuous growth of the mycetoma. Suddenly a purulent gangrene of the whole upper lobe occurred infected by actinomyces israelii and staphylococcus but not aspergillus as it could be demonstrated in specimens from repeated transthoracic needle aspirations. After percutaneously inserted chest-tube drainage during 30 days the upper lobe cavity cleared up and the previously impressive aspergilloma had disappeared completely, however, the serum precipitins from aspergillus fumigatus still remained positive. After a course of several months without further pulmonary complications the patient finally died from a ruptured aortic aneurysm. It is suggested, that the spontaneous lysis of the aspergilloma was due to a deprivation of it' nutritive basis by the infected pulmonary tissue. A similar mechanism may also account for a sometimes successful treatment of pulmonary aspergilloma after injection of an amphotericin containing paste as a novel therapeutic strategy which is recommended in the case of patient's inoperable conditions.