PERCUTANEOUS INTRACAVITARY ANTIFUNGALS FOR A PATIENT WITH PULMONARY ASPERGILLOMA - WITH A SPECIAL REFERENCE TO IN-VIVO EFFICACIES AND IN-VITRO SUSCEPTIBILITY RESULTS

A 61-year-old man with pulmonary aspergilloma received two antifungals intracavitarily. Although clinical, serological and roentgenographic improvement were observed with fluconazole therapy, bronchial secretio ns continuously yielded Aspergillus fumigatus. When fluconazole was sw itched to amphotericin B, the pathogen was eradicated immediately. The minimal inhibitory concentrations (MICs) of the isolate were 400 mug/ ml for fluconazole, and 0.2 mug/ml for amphotericin B. Although the di screpancy between in vitro and in vivo efficacy of antifungals has bee n argued, it was suggested the drug of choice should be selected on th e basis of the MIC results at least in the intracavitary antifungal th erapy for pulmonary aspergilloma.