Chest
selected reportsChronic Necrotizing Pulmonary Aspergillosis*: Approach to Management
Section snippets
Methods
We used MEDLINE® to review the English-language literature published after 1980. Our search terms included Aspergillus, chronic, or necrotizing, or all of these. Summary data are presented in Table 1. A pathologic diagnosis required demonstration of septate hyphae typical of Aspergillus species invading lung parenchyma on biopsy specimens, accompanied by Aspergillus culture growth. When fungal invasion was not demonstrated, criteria for a clinical diagnosis included growth of Aspergillus
Patient 1
A 53-year-old man with COPD experienced increased sputum production, fevers, night sweats, and weight loss for 1 month. The admission chest radiograph revealed a left upper lobe cavitary infiltrate with a pleural-based density. Despite broad-spectrum antibiotic therapy for 2 weeks, his symptoms persisted. Bronchoscopy was performed for a more definitive diagnosis. Bronchial washings grew A niger and cytology revealed no malignancy. In the absence of a diagnosis, continued deterioration and a
Discussion
The cases described here are illustrative of many of the major features of CNPA. CNPA is associated with considerable morbidity and mortality.7, 8 Often, the diagnosis is not made early in the course of illness.8 Even when promptly diagnosed, the pulmonary and systemic abnormalities and potentially toxic therapy combine to make medical treatment only variably effective. Most patients are poor candidates for pulmonary resection, and postoperative complications are common.8 We have reviewed the
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