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Chronic necrotizing pulmonary aspergillosis treated by endobronchial amphotericin B
M R Bennett1, D L Weinbaum, P C Fiehler
1Department of Internal Medicine, Western Pennsylvania Hospital, Pittsburgh 15224.
Abstract:
Chronic necrotizing pulmonary aspergillosis is an indolent, locally invasive form of Aspergillus infection. Treatment options are limited and controversial. Resection is often curative if the patient has sufficient ventilatory reserve. Even though intravenous amphotericin B is effective in a few patients, toxicity limits its use. Aerosolized amphotericin B has proven ineffective. Anecdotal reports of intracavitary and endobronchial antifungal therapy show limited success. Our patient had unresectable chronic necrotizing pulmonary aspergillosis treated successfully with intracavitary instillation of amphotericin B, delivered via the flexible fiberoptic bronchoscope.
Insights
This study presents a successful treatment for chronic necrotizing pulmonary aspergillosis using amphotericin B instillation. This approach offers a new option for patients with unresectable disease.
Area of Science:
- Pulmonology
- Mycology
- Infectious Diseases
Background:
- Chronic necrotizing pulmonary aspergillosis is a challenging fungal infection.
- Limited and controversial treatment options exist for this indolent, invasive Aspergillus infection.
- Surgical resection is curative but not always feasible due to patient ventilatory reserve.
Observation:
- Intravenous amphotericin B has limited use due to toxicity.
- Aerosolized amphotericin B and anecdotal intracavitary/endobronchial therapies show limited success.
- A patient with unresectable chronic necrotizing pulmonary aspergillosis was identified.
Findings:
- Successful treatment of unresectable chronic necrotizing pulmonary aspergillosis was achieved.
- Treatment involved direct intracavitary instillation of amphotericin B.
- Delivery was facilitated by a flexible fiberoptic bronchoscope.
Implications:
- Intracavitary amphotericin B instillation via flexible bronchoscopy is a viable treatment strategy.
- This method offers a potential therapeutic option for patients with unresectable pulmonary aspergillosis.
- Further research may validate this approach for broader clinical application.