Allergic bronchopulmonary aspergillosis with marked peripheral blood eosinophilia and pulmonary eosinophilia:A case report

BACKGROUND Allergic bronchopulmonary aspergillosis(ABPA)is an immune-related pulmonary disease caused by sensitization of airway by Aspergillus fumigatus.The disease manifests as bronchial asthma and recurring pulmonary shadows,which may be associated with bronchiectasis.The diagnosis of ABPA mainly depends on serological,immunological,and imaging findings.Pathological examination is not necessary but may be required in atypical cases to exclude pulmonary tuberculosis,tumor,and other diseases through lung biopsy.CASE SUMMARY An 18-year-old man presented with recurrent wheezing,cough,and peripheral blood eosinophilia.Chest computed tomography showed pulmonary infiltration.There was a significant increase in eosinophils in bronchoalveolar lavage fluid.There was no history of residing in a parasite-endemic area or any evidence of parasitic infection.Pathologic examination of bronchoalveolar lavage fluid excluded fungal and mycobacterial infections.The patient was receiving medication for comorbid diseases,but there was no temporal correlation between medication use and clinical manifestations,which excluded drug-induced etiology.Histopathological examination of lung biopsy specimen showed no signs of eosinophilic granulomatosis with polyangiitis,IgG4-related diseases,or tumors.The diagnosis of ABPA was considered based on the history of asthma and the significant increase in serum Aspergillus fumigatus-specific immunoglobulin(Ig)E.Eosinophil-related diseases were excluded through pathological biopsy,which showed typical pathological manifestations of ABPA.CONCLUSION The possibility of ABPA should be considered in patients with poorly controlled asthma,especially those with eosinophilia,lung infiltration shadows,or bronchiectasis.Screening for serum IgE,Aspergillus fumigatus-specific IgE and IgG,and alveolar lavage can help avoid misdiagnosis.

Progress in diagnosis and treatment of invasive aspergillosis after liver transplantation

Invasive aspergillosis is an opportunistic fungal infection disease,and the risk factors of Invasive aspergillosis after liver transplantation are increasing,which seriously affects the quality of life of patients.Invasive Aspergillus has no specific clinical manifestations and occurs most frequently in the lungs.The diagnostic methods for invasive aspergillosis are continuously updated,including serological tests,polymerase chain reaction(PCR),next-generation sequencing,Matrix-assisted laser desorption ionization time-of-flight mass spectrometry,Aspergillus GM lateral flow test,and some new markers under study have made the diagnosis of invasive aspergillosis infection more definitive.Voriconazole is the drug of choice for the treatment and prevention of invasive aspergillosis,and immunotherapy may become an adjuvant therapy or monotherapy for invasive aspergillosis with the emergence of more and more resistant strains.This article summarizes the progress in the diagnosis and treatment of invasive aspergillosis after liver transplantation,in order to provide a reference for clinical practice.

Invasive aspergillosis in liver transplant recipients, an infectious complication with low incidence but significant mortality

BACKGROUND Infections,including invasive fungal infections(IFIs),are among the leading causes of mortality in liver transplant recipients during the first year posttransplantation.AIM To investigate the epidemiology,clinical manifestations,risk factors,treatment outcomes,and mortality rate of post-liver transplantation invasive aspergillosis(IA).METHODS In this case-control study,22 patients with IA were identified by reviewing the archived and electronic medical records of 850 patients who received liver transplants at the Imam Khomeini Hospital complex in Tehran,Iran,between 2014 and 2019.The control group comprised 38 patients without IA infection matched for age and sex.The information obtained included the baseline characteristics of liver transplant patients,operative reports,post-transplantation characteristics of both groups and information about the fungal infection of the patient group.RESULTS The prevalence rate of IA among liver transplant recipients at Imam Khomeini Hospital was 2.7%.The risk factors of IA among studied patients included high serum creatinine levels before and post-transplant,renal replacement therapy,antithymocyte globulin induction therapy,post-transplant bile leakage,posttransplant hepatic artery thrombosis,repeated surgery within 30 d after the transplant,bacterial pneumonia before the aspergillosis diagnosis,receiving systemic antibiotics before the aspergillus infection,cytomegalovirus infection,and duration of post-transplant hospitalization in the intensive care unit.The most prevalent form of infection was invasive pulmonary aspergillosis,and the most common chest computed tomography scan findings were nodules,pleural effusion,and the halo sign.In the case group,prophylactic antifungal therapy was administered more frequently than in the control group.The antifungal therapy response rate at 12 wk was 63.7%.The 3-and 12-mo mortality rates of the patients with IA were 36.4%and 45.4%,respectively(compared with the mortality rate of the control group in 12 mo,which was zero).CONCLUSION In this study,the prevalence of IA among liver transplant recipients was relatively low.However,it was one of the leading causes of mortality following liver transplantation.Targeted antifungal therapy may be a factor in the low incidence of infections at our facility.Identifying the risk factors of IFIs,maintaining an elevated level of clinical suspicion,and initiating early antifungal treatment may significantly improve the prognosis and reduce the mortality rate of liver transplant recipients.

A Case of Cerebral Aspergillosis in a Patient with Chronic Lymphoid Leukemia

Cerebral aspergillosis commonly affects immunocompromised hosts, primarily patients on immunosuppressive therapy and those with acquired or immunodeficient states such as AIDS. We report a case of cerebral aspergillosis in a 39-year-old woman with a history of treated chronic lymphocytic leukemia (CLL). Multiple fragments of fixed tissues with formalin were freshly sent to the laboratory. An extemporaneous examination was performed by spreading. The rest of the sample was embedded in paraffin and studied according to the standard histological method with special stains and an immunohistochemical study. A microscopic observation showed abundant clusters of tangled mycelial filaments, Grocott+. At the edge, a nervous tissue was observed remodeled by an abundant inflammatory infiltrate consisting essentially of small lymphocytes and plasma cells. Additional immunohistochemistry was performed using anti-CD20, anti-CD3, anti-CD5, anti-CD23, anti-Bcl2, anti-Ki67, anti-IgD and anti-Kappa and Lamda antibodies. All taken together there were no further founding in support of a secondary localization of CLL. Cerebral aspergillosis is quite rare and often occurs in a context of immunosuppression. This case indicates the importance of a close collaboration between clinicians and pathologists for optimal patient care.

High attenuation mucoid impaction in allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis(ABPA) is a complex hypersensitivity syndrome triggered against antigens of Aspergillus fumigatus,a fungus that most commonly colonizes the airways of patients with bronchial asthma and cystic fibrosis.It presents clinically with refractory asthma,hemoptysis and systemic manifestations including fever,malaise and weight loss.Radiologically,it presents with central bronchiectasis and recurrent episodes of mucus plugging.The mucus plugs in ABPA are generally hypodense but in up to 20% of patients the mucus can be hyperdense on computed tomography.This paper reviews the literature on the clinical significance of hyperattenuated mucus in patients with ABPA.

Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis

AIM: To investigate the chest radiographic and high resolution computed tomography (HRCT) chest manifestations in glucocorticoid-na?ve allergic bronchopulmonary aspergillosis (ABPA) patients. METHODS: This is a prospective observational study and includes 60 consecutive glucocorticoid-na?ve patients with ABPA who underwent chest radiography and HRCT of the chest (1.25 mm every 10 mm) in the routine diagnostic workup for ABPA. RESULTS: Chest radiographs were normal in 50% of cases. Of the remainder, most patients demonstrated permanent findings in the form of parallel line and ring shadows suggesting bronchiectasis. Consolidation was detected in 17 cases but in the majority, the corresponding HRCT chest scan showed mucus-filled bronchiectatic cavities. Chest HRCT was normal in 22 patients, while central bronchiectasis (CB) was demonstrated in the remaining 38 patients. Bronchiectasis extended to the periphery in 33%-43% depending on the criteria used for defining CB. The other findings observed on HRCT were mucoid impaction, centrilobular nodules and high-attenuation mucus in decreasing order of frequency. CONCLUSION: Patients with ABPA can present with normal HRCT chest scans. Central bronchiectasis cannot be considered a characteristic feature of ABPA as peripheral bronchiectasis is commonly observed. Consolidation is an uncommon finding in ABPA.

Allergic bronchopulmonary aspergillosis:Lessons for the busy radiologist

The probability of a radiologist interpreting a disease correctly is not only influenced by their training and experience but also on the knowledge of a particular entity.This editorial reviews certain myths and realities associated with radiological manifestations of allergic bronchopulmonary aspergillosis(ABPA).ABPA is a hypersensitivity disorder against the antigens of Aspergillus fumigatus.Although commonly manifesting with central bronchiectasis(CB),the disorder can present without any abnormalities on high-resolution computed tomography(HRCT) of the chest,so-called serologic ABPA(ABPA-S).HRCT of the chest should not be used in screening or in the initial diagnostic work up of asthmatics,as asthma without ABPA can manifest with findings of CB.High-attenuation mucus(HAM) is the pathognomonic sign of ABPA and is very helpful in the diagnosis of ABPA complicating asthma and cystic fibrosis.Instead of classifying ABPA based on the presence and absence of CB into ABPA-CB and ABPA-S respectively,ABPA should be classif ied as ABPA-S,ABPACB and ABPA-CB-HAM.The classif ication scheme based on HAM not only identifies an immunologically severe disease but also predicts a patient with increased risk of recurrent relapses.

Renal aspergillosis in a liver transplant patient: A case report and review of literature

BACKGROUND Aspergillosis is a frequent invasive fungal infection in liver recipients(affecting 1%-9.2% of all patients), second only to candidiasis. Significant risk factors for invasive aspergillosis in liver recipients include corticosteroid therapy, neutropenia, T-cell dysfunction, renal failure and requirement for renal replacement therapy. Aspergillus infection usually affects the lungs of liver recipients, with hematogenous dissemination occurring in 50%-60% of cases. Renal involvement is rare and is considered to occur in 0.4% of all cases of invasive aspergillosis.CASE SUMMARY This paper describes a case of a liver recipient presenting with a newly formed renal mass a year after liver transplantation. The patient underwent liver transplantation due to alcoholic liver cirrhosis, with preoperative corticosteroid therapy and postoperative immunosuppressants(tacrolimus and mycophenolate mofetil). His 1-year follow-up was uneventful, with a satisfying graft function and lack of any symptoms. During a routine follow-up abdominal ultrasound, he was diagnosed with a renal tumor. The renal ima-ging findings were inconclusive(with a differential diagnosis to renal cell carcinoma), while the computed tomography(CT) of the chest showed scar tissue in the lungs suggestive of previous inflammation. The patient underwent radical nephrectomy, with histopathological analysis showing renal aspergilloma, yielding postoperative treatment with voriconazole. His follow up was uneventful, and the chest CT did not show any change in pulmonary lesions. This case illustrates the possibility of aspergillosis affecting the lungs of liver recipients, subsequently affecting the kidney and forming an aspergilloma.CONCLUSION Clinicians should be aware of aspergilloma mimicking solid organ tumors in organ recipients.

Complete withdrawal of glucocorticoids after dupilumab therapy in allergic bronchopulmonary aspergillosis:A case report

BACKGROUND Allergic bronchopulmonary aspergillosis(ABPA)is an allergic reaction to Aspergillus species that aggravates bronchial asthma.Previous studies demonstrated the glucocorticoid-sparing effect of dupilumab in patients with ABPA.There is no report of complete withdrawal of glucocorticoids after dupilumab.CASE SUMMARY The patient was a 54-year-old woman with bronchial asthma treated with inhaled corticosteroids and a long-acting beta-2 agonist.She consulted our institution for productive cough and fever in March 2017.Chest computed tomography scan revealed mucoid impaction,and the bronchial lavage fluid culture was positive for Aspergillus fumigatus.The diagnosis was ABPA.The patient was treated with oral glucocorticoids from April 2017 to November 2017.In January 2019,she had bronchial asthma exacerbation,and a chest computed tomography scan showed recurrent mucoid impaction.She was treated with oral glucocorticoids and itraconazole.In February 2020,during tapering of oral glucocorticoid,she had the third episode of bronchial asthma exacerbation and a mucoid impaction.The patient was treated with dupilumab in addition to oral glucocorticoid and itraconazole.The clinical response improved,and oral glucocorticoid was discontinued in June 2020.CONCLUSION This is the first case of ABPA in which complete withdrawal of glucocorticoid was possible after treatment with dupilumab.

Value of eosinophil count in bronchoalveolar lavage fluid for diagnosis of allergic bronchopulmonary aspergillosis: A case report

BACKGROUND An immediate hypersensitive immune response to Aspergillus fumigatus antigens is one of the main characteristic features of allergic bronchopulmonary aspergillosis(ABPA).As ABPA is an allergic respiratory disease,immunoglobulin E and peripheral-blood eosinophilia have been used as diagnostic indicators.However,eosinophilia in bronchoalveolar lavage fluid(BALF)has not been considered in the diagnostic criteria for ABPA.CASE SUMMARY We present a case of ABPA in which the eosinophil count in peripheral blood was not increased,whereas the eosinophil percentage in BALF reached 60%.After antifungal and hormone therapy,imaging revealed very good resolution of lung infiltration.CONCLUSION The value of the eosinophil count in BALF for the diagnosis of ABPA is worthy of the clinician's attention,especially when the patient’s clinical features lack specificity and the diagnostic parameters are negative.

Allergic fungal rhinosinusitis accompanied by allergic bronchopulmonary aspergillosis: A case report and literature review

BACKGROUND Concomitant allergic fungal rhinosinusitis(AFRS)and allergic bronchopulmonary aspergillosis(ABPA)are extremely rare,with no more than 20 cases reported in the English literature.CASE SUMMARY A 52-year-old female patient complained of right-sided nasal obstruction,rhinorrhea,sneezing,epistaxis,and hyposmia for a period of around 5 mo.Nasal examination detected paleness and edema of the nasal mucous membrane and a polyp in the right middle meatus.A computed tomography(CT)scan of the sinuses revealed a ground-glass opacity filling the right maxillary and ethmoid sinuses,along with bone absorption in the medial wall of the right maxillary sinus.Magnetic resonance images were obtained with T1-weighted,T2-weighted,and gadolinium-enhanced T1-weighted sequences.A well-defined mass,located in the right maxillary and ethmoid sinuses and displaying obvious hypointense features,was observed on both T1-and T2-weighted images,with peripheral enhancement on gadolinium-enhanced T1-weighted images.The patient also has a 20-year history of cough and dyspnea.Chest CT revealed columned and cystiform bronchiectasis in the bilateral bronchus,surrounded by a large number of spotted and funicular high-density lesions.The level of serum total IgE was>5000 kU/L.Serum IgE levels related to house dust and aspergillus showed a positive result,with the values being 3.5 kU/L and 1.2 kU/L.We performed functional endoscopic sinus surgery under local anesthesia.After surgery,topical glucocorticoids and saline irrigation were applied in the nasal cavity until the present time.An oral glucocorticoid(methylprednisolone 16 mg/d)and antifungal agent(itraconazole 200 mg/d)were also used for a period of 4 wk.Montelukast was prescribed at 10 mg/d until the present time.An endoscopic examination showed that the patient was recovering well at 3 mo after surgery.CONCLUSION Since different specialists treat ABPA and AFRS,their coexistence may be overlooked.AFRS accompanied by ABPA requires surgical therapy combined with medical control to improve the symptoms.

Remission of hepatotoxicity in chronic pulmonary aspergillosis patients after lowering trough concentration of voriconazole

BACKGROUND Chronic pulmonary aspergillosis(CPA)is a rare syndrome that is often accompanied by gradual lung tissue destruction.Voriconazole is usually employed as the first-line agent for CPA treatment.However,some patients can develop hepatotoxicity and often were forced to stop voriconazole treatment.AIM To record the improving trend of liver function and the therapeutic effects in patients after lowering the trough concentration of voriconazole.METHODS This study retrospectively analyzed 12 adult CPA patients who developed hepatotoxicity during the voriconazole treatment.In these patients,the oral dose was reduced to 3/4 or 1/2 of the standard dose(4 mg/kg,twice daily),and the lower limit of voriconazole trough concentration was maintained more than 0.5μg/m L.The trend of remission of liver toxicity after drug reduction in 12 patients was recorded.During the same period,25 patients who received standard doses served as the control group.Data from the two groups were collected and analyzed for different parameters such as demographic characteristics,underlying pulmonary disorders,laboratory tests,and therapeutic effect.The differences between the two groups were statistically compared.RESULTS Hepatotoxicity occurred in 12 patients within 28-65 d after oral voriconazole treatment.Hepatotoxicity was mainly manifested by the significantly increased level of gamma-glutamyltransferase and a slight increase of alanine aminotransferase and aspartate aminotransferase.The oral dose of voriconazole was reduced to approximately 3 mg/kg in seven patients and approximately 2 mg/kg in five patients.The average trough concentrations for the 12 patients before and after voriconazole oral dose reduction were 3.17±1.47μg/m L(1.5-6.0μg/m L)and 1.70±0.78μg/m L(0.6-3.3μg/m L),respectively(P=0.02).After lowering the trough concentrations,the hepatotoxicity was alleviated in all the patients.However,gamma-glutamyltransferase levels declined slowly.After 4 mo of treatment,7 of the 12 patients were successfully treated in the low trough concentrations group(41.7%).Similarly,8 of the 25 patients in the standard treatment dose group(32.0%)were effectively treated.There was no statistical difference between the groups(P=0.72).CONCLUSION Reducing the lower limit of the voriconazole trough concentration to 0.5μg/m L can alleviate the hepatotoxicity and maintained certain clinical efficacy in CPA patients;however,patients should be closely monitored.

Invasive aspergillosis presenting as hilar masses with stenosis of bronchus: A case report

BACKGROUND Hilar masses with stenosis of the bronchus occur mainly due to malignant diseases,such as lung cancer.Hilar masses resulting from invasive aspergillosis are extremely rare and occur mostly in severely immunosuppressed patients.CASE SUMMARY In the current case report,we have documented a unique case of invasive aspergillosis presenting as a mass in the hilum and bronchial stenosis under bronchoscopy mimicking lung cancer in a 54-year-old man with diabetes mellitus.The histological analysis of bronchial membrane biopsy demonstrated fungal elements of 45°branching hyphae with positive Periodic Acid-Schiff and Grocott staining.After 3 mo of antifungal therapy,the symptoms,computed tomography scan and bronchoscopy manifestations all showed improvement.CONCLUSION We highlight that clinicians should consider a diagnosis of invasive aspergillosis when radiological examination shows pseudotumor appearance in diabetes mellitus patients.

Therapeutic potential of Calotropis gigantea extract against invasive pulmonary aspergillosis:In vitro and in vivo study

Objective:To characterize the antifungal activity of methanolic leaf extract of Calotropis gigantea alone or in combination with amphotericin B against invasive pulmonary aspergillosis in mice.Methods:GC/MS was used for analysis of active constituents of Calotropis gigantea extract.Spore germination assay and broth micro-dilution method were used to determine antifungal potential of Calotropis gigantea/amphotericin B against Aspergillus fumigatus.Neutropenic mice were randomly assigned into 5 groups:group 1 was neutropenic(control);group 2 was infected with Aspergillus fumigatus;group 3 was infected with Aspergillus fumigatus,and treated with Calotropis gigantea extract;group 4 was infected with Aspergillus fumigatus and treated with amphotericin B;group 5 was infected with Aspergillus fumigatus and treated with both Calotropis gigantea extract and amphotericin B.Fresh lung tissues were histopathologically examined.Fungal burden and gliotoxin concentration were evaluated in lung tissues.Catalase,superoxide dismutase,and malondialdehyde content were determined in lung tissues.Myeloperoxidase,tumor necrosis factor-alpha,interleukin-1,and interleukin-17 were also estimated by the sandwich enzyme-linked immuno-sorbent assay.Results:Calotropis gigantea/amphotericin B had a minimum inhibitory concentration and minimum fungicidal concentration of 80 and 160μg/mL,respectively,for Aspergillus fumigatus.Additionally,Calotropis gigantea/amphotericin B significantly reduced lung fungal burden by 72.95%and inhibited production of gliotoxin in lung tissues from 6320 to 1350μg/g lung.Calotropis gigantea/amphotericin B reduced the oxidative stress of the lung via elevating the activity of antioxidant enzymes and decreasing the levels of lipid peroxidation.Myeloperoxidase activity and the production of pro-inflammatory cytokines were also significantly reduced.Scanning electron microscopy revealed deteriorations in the hyphae ultrastructure in Calotropis gigantea/amphotericin B treated Aspergillus fumigatus and leak of cellular components after damage of the cell wall.In vivo study revealed the suppression of lung tissue damage in mice of invasive pulmonary aspergillosis,which was improved with Calotropis gigantea/amphotericin B compared to the control group.Conclusions:Calotropis gigantea/amphotericin B is a promising treatment to reduce lung fungal burden and to improve the drugs’therapeutic effect against invasive pulmonary aspergillosis.

The Effect Analysis of Different Experimental Methods for the Diagnosis of Invasive Pulmonary Aspergillosis in a Rat Model

Background: Consensus on the most reliable assays to detect invasive aspergillosis from minimally or noninvasive samples has not been reached. In this study, we compared the efficacy of an enzyme-linked immunosorbent assay (ELISA) for galactomannan (GM) detection and quantitative real-time PCR assay (qRT-PCR) for the diagnosis of invasive pulmonary aspergillosis in a rat model. Methods: Neutropenic, male Sprague-Dawley rats (specific pathogen free;8 weeks old;weight, 200 ± 20 g) were immunosuppressed with cyclophosphamide and infected with Aspergillus fumigatus intratracheally. Tissue and whole blood samples were harvested on days 1, 3, 5, and 7 post-infection and examined with GM ELISA and qRT-PCR. Results: On day 7, A. fumigatus DNA was amplified from 14 of 48 whole blood samples from immunosuppressed infected rats: day 1 (0/12), day 3 (0/12), day 5 (6/12), day 7 (8/12) post infection. The sensitivity and specificity of the qRT-PCR assay were 29.2% and 100%, respectively. Receiver operating characteristic curve (ROC) analysis indicated a Ct cut-off value of 15.35, and the area under the curve (AUC) was 0.627. The GM assay detected antigen in sera obtained on day 1 (5/12), day 3 (9/12), day 5 (12/12), and day 7 (12/12) post-infection, and thus had a sensitivity of 79.2% and a specificity of 100%. The ROC of the GM assay indicated that the optimal cut-off value was 1.40 (specificity, 100%;AUC, 0.919). Conclusions: The GM assay was more sensitive than qRT-PCR assay in diagnosing invasive pulmonary aspergillosis in rats.

Unilateral Frontal Sinus Aspergillosis: A Case Report and Review Literature

Frontal sinus aspergillosis is a rare infection that can be usually associated with immunocompromised states and life-threatening with high mortality rate. The authors report in a developing country a case of immunocompetent patient with left unilateral frontal headache, associated with left eye ptosis. The Brain CT Scan revealed frontal sinus aspergillosis. She underwent surgery followed by itraconazole cure. The outcome is successful after a period of 14 months with resolution of symptomatology. Anatomopathological examination confirmed aspergillosis. They share their experience of management of this disease in a country where neurosurgery is very young specialty and where molecules against aspergillosis are not available.

A Report of 2 Cases of Disseminated Invasive Aspergillosis with Myocarditis in Immunocompromised Patients

Invasive aspergillosis is a life-threatening opportunistic infection that occurs most often in immunocompromised patients, especially those with either hematological malignancies treated with chemotherapy or in organ transplant recipients. Here, we report 2 cases of disseminated invasive aspergillosis with myocarditis proven pathologically by autopsy. These 2 cases occurred in immunocompromised patients: the first patient received chemotherapy for acute myeloid leukemia with myelodysplasia-related changes (AML-MRC);the second patient received methotrexate therapy for rheumatoid arthritis (RA). Invasive aspergillosis with myocarditis has high morbidity and mortality rates, therefore it is necessary to make prompt diagnosis and to start intensive treatments quickly.

Pulmonary aspergillosis in a patient with COPD due to PEG-interferon and ribavirin therapy for chronic hepatitis C

This is a case of 52 years old male patient with chronic obstructive pulmonary disease (COPD) who developed semi-invasive pulmonary aspergillosis while on pegylated-interferon alpha-2a and for chronic hepatitis C infection. This complication is very rarely seen during interferon therapy for other any purposes. Pulmonary aspergillosis in particular group of chronic hepatitis C patients under immunosupressive therapy should also be in mind and interdisciplinary medical cooperation might be needed during the treatment for immune-suppressed patients. Pulmonary aspergillosis is also discussed from many aspects in the light of the literature.

Diagnosis and treatment of lung aspergillosis after liver transplantation

Objective To assess the diagnosis and treatment of invasive lung aspergillosis after liver transplantation. Methods Routine sputum culture was performed. Itraoonazole were used to prevent fungal infection prophylactically. Amphyotericin B was only used on aspergillosis. In 54 patients receiving, liver transplantation, 3 patients with lung June 2003 Vol12 No2 aspergillosis were reviewed. Results Of the 3 patients 2 died and 1 recovered. Conclusion Overimrnnosuppression is a main risk factor for aspergillosis. Amphotericin B is still the best choice for the treatment of aspergillosis and its gradual, interrupted, low concentration administration, cooperated with itraconazole can ease the side effects. 5 refs.

A Case of Invasive Pulmonary Aspergillosis Resulted from the Treatment of Chronic Eczema

This was an advanced male(87-year-old)with refractory chronic eczema for over 40 years,based on his allergic constitution,accompanied with chronic kidney disease due to primary hypertension(CKD,phase 3).It was so difficult to tolerate the severe itching that the glucocorticoids(GC)had to be applied to it,but some new-onset respiratory symptoms,such as cough,dyspnea after exertion etc.,occurred to this patient.Some classical IPA images were found on his pulmonary CT scanning,which were further comfirmed by the positive findings of GM-test,and then a final diagno­sis of IPA was accordingly established.Unfortunately,a persistent fever emerged after starting an antifungal therapy to the patient,and his IL-2 level was detected to be superhigh.As a response to allergic fever,GC was carefully given intravenously again to treat it,and it turned out to be totally improved since then;suggesting that systemic thinking(integrated with the other clinical evidences)is essential to diagnose IPA,and GC can also be used to improve its symptoms with the existence of antifungal therapy.