[Pleuropulmonary aspergillosis with defective neutrophil functions--G-CSF effects on neutrophil functions]

A 66-year-old man was admitted to our hospital with productive cough and fever. Chest X-ray films showed pleural thickening of the right apex and calcification of the lung field. Antibiotic therapy was administered but no improvement was obtained. Chest CT scan revealed pleural thickening with effusion in the right apex. Needle aspiration biopsy was performed and Aspergillus fumigatus was isolated from pleural fluid. We began pleural drainage and intrapleural infusion of miconazole, with systemic administration of miconazole, amphotericin B and fluconazole. In spite of normal bone marrow findings, the neutrophil functions, NAP score and phagocytosis, of the patient were found to be subnormal. We commenced to treatment with granulocyte colony stimulating factor and his neutrophil functions improved (NAP score: 156-->309.5, phagocytosis: 64.9-->70.0%). However, his fever persisted and he died following cardiopulmonary arrest. Autopsy revealed Aspergillus mycelia invading the visceral pleura. No intrapulmonary lesions caused by Aspergillus were found.