[Chronic necrotizing pulmonary aspergillosis treated with itraconazole and inhaled amphotericin B]

A 52-year-old man with chronic necrotizing pulmonary aspergillosis complicated by a residual tuberculous cavity was admitted to the hospital because of fever and a new infiltration shadow in the right lower lobe. Aspergillus was isolated repeatedly from his sputum, though he had been treated with itraconazol for 9 months. Combination therapy with itraconazol (200 mg) and inhaled amphotericin B (AMPC, 10 mg, 4 times a day) was begun. The infiltration shadow gradually resolved. The concentration of AMPC in serum was measured by high-performance liquid chromatography, and was found to be 0.09 micrograms/ml, which is equal to the AMPC concentration obtained with daily oral administration of 2400 mg. This case shows that, contrary to previous opinion, AMPC can be effectively administered by inhalation. We know of no previous reports of similar cases. In addition, itraconazol and inhaled AMPC may have had a synergistic effect in this case.