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BMJ Case Reports 2013; doi:10.1136/bcr-2012-007925
  • CASE REPORT

Successful pneumonectomy for invasive pulmonary aspergillosis and advanced non-small cell-lung cancer

  1. Kunihiko Kobayashi1
  1. 1Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka-shi, Saitama, Japan
  2. 2Department of Respiratory Medicine, Jichi Medical University Saitama Medical Center, Saitama-shi, Saitama, Japan
  3. 3Department of Respiratory Surgery, Saitama Medical University International Medical Center, Hidaka-shi, Saitama, Japan
  1. Correspondence to Dr Nobuyuki Koyama, nkoyama{at}jichi.ac.jp

Summary

Aspergillus spp. is a pathogenic fungus in patients with malignancy, immunosuppression or respiratory diseases, and invasive pulmonary aspergillosis (IPA) caused by its infection is an aggressive and often lethal disorder. We report a case of non-small-cell lung cancer (NSCLC) where pneumonectomy concomitantly enabled radical cure of the underlying disease and IPA against which different antifungal drugs had been ineffective. In a patient with locally advanced NSCLC that progressed despite chemoradiation, radiation pneumonitis and subsequently cavitary disease developed following the administration of corticosteroids. Based upon the isolation of Aspergillus spp. from sputum, a diagnosis of IPA was made and since the latter was refractory to multiple antifungal drugs, pneumonectomy was undertaken which resulted in successful treatment of both NSCLC and IPA. Surgical intervention should be considered as a therapeutic option for IPA complicating NSCLC that is refractory to medical management.

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