[A case of chronic necrotizing pulmonary aspergillosis effectively treated with miconazole inhalation]

A 63-year-old male was hospitalized due to persistent cough on August 19, 1991. He was suspected to have pulmonary tuberculosis based on the findings of chest roentgenograms. He was therefore given anti-tuberculous drugs and antibiotics as of the first hospital day. Approximately two months later, he developed high fever, and the infiltrative shadows on his chest roentgenograms worsened. Therefore, he was readmitted to our hospital on October 31, 1991. Despite the use of several antibiotics, his high fever persisted and the infiltrative shadows on chest roentgenography continued to worsen after admission. Although no pathogenic microorganisms were isolated, in spite of frequent sputum examinations, we strongly suspected pulmonary aspergillosis because serum precipitin antibody against aspergillus antigens was positive. Intravenous administration of miconazole was thus initiated and lead to reduction in the fever. The fever recurred but, after the start of miconazole inhalation, gradually diminished. Serum precipitin antibody subsequently became negative. We diagnosed this case as chronic necrotizing pulmonary aspergillosis based on the clinical course. It is often difficult to confirm the presence of aspergillus hyphae. Therefore, this disease should be suspected on the basis of serum precipitin antibody. In such cases, a therapeutic diagnosis should be attempted.