[A case of pulmonary aspergilloma successfully treated with transbronchial intracavitary itraconazole].

A 74-year-old woman given a diagnosis of chronic necrotizing pulmonary aspergillosis in February, 2007 was treated by intravenous voriconazole (VRCZ) and her conditions improved. Then it was switched to oral VRCZ and continued treatment. However, a fungus ball remained, and (1-3)-beta-D-glucan values increased, which had previously been within normal limit. Therefore transbronchial intracavitary itraconazole therapy was performed twice a week, for a total of 9 times (715 mg) from June, 2007. The fungus ball disappeared at the time of the fourth injection, and (1-3)-beta-D-glucan values decreased gradually. Intravenous ITCZ was administered for two weeks from July, 2007, after which it was switched to oral ITCZ 400 mg/day and treatment was continued without recurrence. Though intracavitary ITCZ therapy caused temporary fever and elevation of CRP, we were able to perform the treatment safely and confirm the elevation of enough serum ITCZ concentrations. This is the first case of pulmonary aspergilloma successfully and safely treated with transbronchial intracavitary itraconazole.