Date: 26 November 2013
Copyright: n/a
Notes:
MS is a 59 year old diabetic patient requiring insulin. He had asthma since childhood, previous episodes of vasculitis, a retinopathy and renal dysfunction. In 1997 Mycobacterium avium intracellulare infection of the lung was diagnosed and successfully treated over a 12 month period. Shortly after this treatment was completed an aspergilloma was noted in the right upper lobe in September 1998. This was untreated for 2 years with progressive enlargement of the cavity most consistent with chronic necrotising pulmonary aspergillosis (CNPA), until the patient became unwell, when benefit from itraconazole was seen. Unfortunately the patient subsequently developed a squamous cell carcinoma and died.
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Image A
CT Scan 30/3/99
Showing extreme pleural thickening and 2 small cavities at apex of left lung.
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A 43 year old with smoking related emphysema was admitted to hospital with two separate episodes of haemoptysis. He had been in good health up to 1989, when he was diagnosed as having bilateral pulmonary tuberculosis. At that time a CT scan revealed a cavity in the left upper lobe (20.8cm2) with adjacent confluent infiltrates and pleural thickening. On bronchoscopic examination no abnormalities were noted and endobronchial biopsies did not reveal hyphae.
Over the next 4 years his condition deteriorated and a CT scan showed the left upper lobe cavity had increased to 40cm2. Itraconazole 400mg daily was prescribed. There was some clinical improvement on itraconazole but patient eventually deteriorated with breathlessness and with significant weight loss.
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