Pulmonary aspergillosis complicating chronic septic granulomatous disease.Treatment with itraconazole and interferon gamma

A 20-year-old patient suffering from chronic granulomatous disease develope d pulmonary aspergillosis with thoracic wall invasion. Treatment with itrac onazole combined with 3-weekly injections of interferon gamma (INF gamma) i mproved the patient's general state of health within two months. Functional signs resolved totally and x-ray images continued to improve for 6 months. INF gamma was withdrawn after 11 months and was replaced with cotrimoxasol e. Itraconazole was continued in a long-term regimen. Four years after onse t of treatment, the clinical status of the patient remained satisfactory an d the radiological aspect was unchanged Pulmonary aspergillosis affects up to 40% of patients suffering from chroni c granulomatous disease. Mortality is high, to the order of 25%. The classi cal treatment is based on amphotericin B, but this case points out the sign ificant contribution of itraconazole as first-line therapy. This antimycoti c has been suggested for prophylaxis. The combined use of INF gamma can be discussed due to the uncertainties about its long-term effects and because of the requirement for 3-weekly injections. High cost is another important consideration.