fluticasone and Aspergillosis--Allergic-Bronchopulmonary

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder resulting from immune responses directed against inhaled Aspergillus fumigatus antigens. It manifests with poorly controlled asthma, fleeting pulmonary opacities and structural lung damage in the form of bronchiectasis. Initially defined in individuals suffering from bronchial asthma and cystic fibrosis, it has also been described in patients with other structural lung disorders such as chronic obstructive pulmonary disease, pulmonary tuberculosis, idiopathic bronchiectasis and others. Kartagener syndrome is a manifestation of primary ciliary dyskinesia characterised by the presence of dextrocardia, bronchiectasis and chronic sinusitis. We report a case of ABPA in an adult suffering from Kartagener syndrome. We also performed a systematic review of the literature on the association between Kartagener syndrome and ABPA.

Topics: Adult; Antifungal Agents; Aspergillosis, Allergic Bronchopulmonary; Bronchodilator Agents; Fluticasone; Formoterol Fumarate; Glucocorticoids; Humans; Kartagener Syndrome; Male; Prednisolone; Radiography

A 58-year-old woman had a productive cough but not from bronchial asthma. A chest radiograph revealed infiltrative shadows in right middlelung field on September, 2004. Aspergillus fumigatus was detected in a sputum culture. She was treated with oral itraconazole. After the treatment, infiltrative shadows on her chest radiograph disappeared. On October 2005, her peripheral blood showed eosinophilla, a high serum level of total immunoglobulin E (IgE), and a chest radiograph revealed new infiltrative shadows in both lung fields. A chest computed tomography revealed multiple nodular shadows and central bronchiectasis. We detected a mucoid plug which showed a large number of eosinophils pathologically by bronchoscopy. Aspergillus niger was detected in a bronchial lavage fluid. We therefore made a diagnosis of allergic bronchopulmonary aspergillosis (ABPA). The decreases of peripheral blood eosinophils and a serum IgE level were recognized and multiple nodular shadows disappeared by reinstitution of itraconazole. However, a chest computed tomography revealed new infiltrative shadows. Therefore, we treated her with the concomitant administration of oral itraconazole and inhaled corticosteroid. All laboratory data and image findings were improved. It is critical to consider the both aspects of allergy and infection in the treatment for ABPA.

Topics: Administration, Inhalation; Androstadienes; Antifungal Agents; Aspergillosis, Allergic Bronchopulmonary; Aspergillus fumigatus; Aspergillus niger; Drug Therapy, Combination; Female; Fluticasone; Humans; Itraconazole; Middle Aged; Treatment Outcome

Topics: Administration, Inhalation; Androstadienes; Anti-Allergic Agents; Antifungal Agents; Aspergillosis, Allergic Bronchopulmonary; Asthma; Bronchiectasis; Cushing Syndrome; Drug Interactions; Fluticasone; Humans; Hydrocortisone; Itraconazole; Male; Middle Aged

A 22-year-old woman has been treated with inhaled corticosteroid for bronchial asthma. Her family moved house to Toyama prefecture in March 2003, and she was enrolled in our hospital. Her chest radiograph on first medical examination showed the right upper lobe infiltration. Bronchoscopy revealed a mucoid impaction at right B2, and Aspergillus fumigatus was cultured from suctioning of pulmonary secretions. Histopathologic findings from transbronchial biopsy revealed eosinophilic pneumonitis but not Aspergillus fumigatus. She was diagnosed allergic bronchopulmonary aspergillosis, and she was started on prednisolone 40 mg/day. The finding of her chest radiograph improved in two weeks. This case suggested that allergic bronchopulmonary aspergillosis was triggered by moving house with exposure of Aspergillus fumigatus. We should give guidance to asthmatics to wear a dust respirator at work in dust-laden environment.

Topics: Adult; Androstadienes; Aspergillosis, Allergic Bronchopulmonary; Aspergillus fumigatus; Dust; Female; Fluticasone; Humans; Prednisolone; Treatment Outcome

The case history is presented of a patient with cystic fibrosis in whom the treatment of allergic bronchopulmonary aspergillosis with itraconazole produced an initial response but was complicated by profound adrenal shutdown and impairment of inhaled steroid clearance resulting in paradoxical Cushing's syndrome. The authors conclude that, while it is laudable to attempt to reduce the steroid burden in any patient, it is imperative that due vigilance is exercised when using a combination of agents which interact. If such a combination therapy is embarked upon, regular assessment of the pituitary adrenal axis is advisable.

Topics: Adult; Androstadienes; Anti-Inflammatory Agents; Antifungal Agents; Aspergillosis, Allergic Bronchopulmonary; Cushing Syndrome; Drug Interactions; Fluticasone; Humans; Itraconazole; Male