UNUSUAL FORM OF ENDOBRONCHIAL ASPERGILLOSIS IN A PATIENT WITH CYSTIC-FIBROSIS

The isolation of Aspergillus fumigatus from airway secretions from pat ients with cystic fibrosis (CF) is common and usually denotes asymptom atic colonization or allergic bronchopulmonary aspergillosis (ABPA). A 12-year-old boy with CF acutely developed moderately severe symptoms of unremitting cough, fever, dyspnea, weight loss, and cyanosis. Chest radiographs demonstrated widespread unilateral infiltrates and volume loss. By bronchoscopy tenacious mucous plugs were seen occluding the left lower lobe bronchus. Cultures from sputum and sequential bronchoa lveolar lavage grew Aspergillus fumigatus, but other significant crite ria for diagnosing APBA were lacking. No improvement was seen with a 3 week course of systemic corticosteroid and antibiotic therapy. Treatm ent with amphotericin B and short-term mechanical ventilation resulted in rapid resolution of all symptoms. This form of endobronchial asper gillosis has not been described previously. (C) 1993 Wiley-Liss, Inc.