3 CASES OF BRONCHIAL STUMP ASPERGILLOSIS - UNUSUAL CLINICAL PRESENTATIONS AND BENEFICIAL EFFECT OF ORAL ITRACONAZOLE

Bronchial stump aspergillosis (BSA), i.e. Aspergillus infection of bro nchial granulation tissue surrounding endobronchial suture threads, is a very rare variant of localized suppurative bronchial Aspergillus in fection, The majority of reported cases have occurred within one year after lung surgery. We present three more patients, in whom BSA occurr ed very late (4.5, 6 and 7 yrs) after pulmonary resection, Other unusu al features were: complete absence of symptoms in one patient, and sim ultaneous occurrence of aspergilloma in another, Removal of the endobr onchial suture probably constitutes the key therapy for BSA. In all th ree of our patients oral itraconazole resulted in clinical, histologic al and microbiological improvement. In conclusion, BSA should be consi dered in the differential diagnosis of haemop tysis occurring up to 7 yrs after lung surgery, although an asymptomatic presentation is possi ble. Furthermore, BSA can be associated with other clinical presentati ons of Aspergillus infection, e.g. aspergilloma, Finally, long-term or al itraconazole therapy may represent a valid alternative when removal of the suture is not feasible.