[A case of Aspergillus empyema with bronchopleural fistula]

Pleural aspergillosis is not a common disease and we recently experienced a case of Aspergillus empyema with bronchopleural fistula. A 76 year-old man was admitted to our hospital with productive cough and fever. Chest X-ray films showed infiltration in the right lower and left middle field and rather lucent area (clearing) in the right lower lung. Antibiotic therapy was administered but no improvement was obtained. Chest CT scan and right bronchography revealed empyema in the right back portion and bronchopleural fistula in the right lower lobe. Needle aspiration biopsy was performed and Aspergillus fumigatus was isolated from pus. A diagnosis of Aspergillus empyema with bronchopleural fistula was made. We began intrapleural administration of miconazole and empyema was improved partially. For the complete treatment, right lower lobectomy and decortication were performed, but unfortunately he died of acute pneumonia 16 days after operation.