[A case of chronic necrotizing pulmonary aspergillosis diagnosed using percutaneous intracavitary endoscopy]

A 65-year-old man with pneumoconiosis visited our hospital for dyspnea on effort. Chest radiography and computed tomography on admission showed cavities with an air-fluid level, consolidation in the right lower lung, and right pleural effusion. The thoracic cavity and an infected cyst were drained, and antibiotics were administered. On detection of molds like Aspergillus species and of aspergillus antigen from the sputum, aspergillosis was suspected and amphotericin B was administered intravenously. Renal dysfunction caused by amphotericin B led to its withdrawal. Abnormal shadows in the chest radiographs and computed tomograms did not improve. To aid in diagnosis, percutaneous intracavitary endoscopy was performed. Yellow-white mural nodules resembling cauliflower were found on endoscopic examination, and a biopsy specimen of the nodules showed hyphae of Aspergillus. Aspergillus fumigatus was cultured from the intracavity fluid. Pulmonary aspergillosis was diagnosed and amphotericin B was administered via the drainage catheter in order to protect renal function. The abnormal shadows then disappeared and the subsequent clinical course was good. In this case, percutaneous intracavitary endoscopy was useful in diagnosing pulmonary aspergillosis.