Pulmonary aspergilloma successfully treated with long-term intermittent inhalation therapy with miconazole

A 63-year-old man developed pulmonary aspergilloma and was given antifungal agents systemically. However adverse reactions, including renal dysfunction and gastric ulcer necessitated discontinuation of the treatment. Transbronchial infusion of miconazole was also unsuccessful because of an asthmatic attack during the procedure. Inhalation of miconazole was started once a week, resulting in remarkable improvement after 6 months of treatment both symptomatically and radiologically without any adverse reactions. We believe that long-term intermittent inhalation therapy with miconazole is well tolerated and useful in patients with aspergilloma, particularly when systemic treatment is difficult because of other underlying diseases or adverse reactions.