Background Pleural aspergillosis (PA) was first described in 1842 but remains a relatively rare entity when compared with other Aspergillus infections.

Purpose To describe the pharmacological management of a patient diagnosed with PA and the efficacy of intracavitary instillation of amphotericin B (ICAB) treatment.

Material and methods A 32-year-old woman with multiple drug allergy syndrome (NSAIDs, pyrazolones, quinolones, lincosamides, SSRIs, ondansetron) was admitted to our hospital because of postoperative Pseudomonas pneumonia complicated with empyema and bronchopleural fistula. The patient underwent thoracostomy. Pleural biopsy showed septate fungal hyphae and pleural fluid culture grew Aspergillus fumigatus while serum galactomannan antigen was negative. Systemic antifungal therapy, with oral voriconazole at first and then with posaconazole, was started. Concurrently, amphotericin B deoxycholate, diluted in 75 ml of 5% glucose solution, was infused directly into the pleural cavity, at 5 mg on the first day, rising to 10 mg and 25 mg on the second and third day, respectively, and then 50 mg, after washing of the pleural cavity with 5% glucose solution. Daily dressing with amphotericin B-impregnated gauze was introduced in the cavity. Local treatment was continued for about two weeks.

Results The treatment was well tolerated with no adverse drug reactions. The symptoms and the physical signs improved greatly during hospitalisation and the patient left the hospital 3 days after the end of treatment. Repeat pleural fluid culture was negative 2 weeks after the end of treatment.

Conclusion ICAB may improve the efficacy of systemic antifungal therapy and it should be considered as an additional treatment option. Moreover, the use of this method avoids repeated needling of the cavity and may allow extended treatment on a domiciliary basis.

Reference

1. Kravitz JN, Berry MW, Schabel SI, et al. A modern series of percutaneous intracavitary instillation of amphotericin B for the treatment of severe hemoptysis from pulmonary aspergilloma. Chest 2013;143(5):1414–21

ReferenceNo conflict of interest.