Chronic Necrotizing Pulmonary Aspergillosis: Pathologic Outcome After Itraconazole Therapy

Objective: To characterize chronic necrotizing pulmonary aspergillosis (CNPA) clinically, radio-graphically, and pathologically and to describe its response to treatment.

Material And Methods: We present three cases of well-documented CNPA and detail the long-term clinical and pathologic responses to the new antifungal triazole, itraconazole.

Results: Although all three patients had an appreciable clinical response to itraconazole therapy, tissue obtained at the time of operation or autopsy revealed residual CNPA despite 5 to 12 months of treatment. Even though pathologic resolution of the CNPA did not occur, patient prognosis was determined solely by comorbid illness.

Conclusion: Itraconazole seems to be effective in CNPA when used in a suppressive (rather than curative) role in patients with limited life expectancy.