[A case of Wegener's granulomatosis]

A 73-year-old man who had been diagnosed with bronchiectasis in 2002 was admitted to our hospital with hemoptysis in March 2003. Upon detecting P. aeruginosa from his sputum culture, we diagnosed his condition as an exacerbation of a chronic respiratory infection with bronchiectasis. Levofloxacin was effective and his infection condition was resolved. In June 2006 he was admitted to our hospital again with hemoptysis and complaining of fever. This time, Levofloxacin was not effective. After admission, fourth-generation cephem, carbapenem, and new quinolone antibiotics were ineffective. However, micafungin sodium seemed to combat the infection. The patient was negative for PR-3 ANCA in laboratory testing, but histological findings of a transbronchial lung biopsy and middle nasal concha supported a diagnosis of Wegener's granulomatosis. Antitubercular drugs and antibiotics have been reported as effective against Wegener's granulomatosis, but we found no evidence of benefits with antifungal agents such as micafungin sodium. Recently however, a case has been reported of murine systemic vasculitis caused by Candida albicans extract. Our case suggests the possible involvement of fungus in the pathogenesis and progression of Wegener's granulomatosis.