Therapeutic approach in pulmonary mycetoma - Analysis of 27 patients

Background. Pulmonary mycetoma is a characteristic clinical-radiological le sion due to colonization of aspergillus or candida species in pre-existing pulmonary cavities following a number of diseases. Methods. We revisited 27 records of such admitted patients (19 M, 8 F; rang e age 16-27 yrs) analysing diagnostic approach and therapy. Predisposing co nditions were sequelae of tuberculosis or lung abscess, bronchiectasis, bul lous emphysema, leukaemia/ lymphoma, diabetes mellitus, corticosteroids and /or immune-suppressant administration and antiblastic chemotherapy. All pat ients had a characteristic chest X-ray and the most common symptoms were co ugh and haemoptysis. Diagnosis of pulmonary mycetoma was based on positive sputum culture for aspergillus or candida species and/or positive result fo r aspergillus precipitin test. Eleven patients received only medical treatm ent, eight pts only a surgical one and eight patients both medical and surg ical ones. Antifungal drugs administered were itraconazole or amphotericin B or fluconazole. Results. In the follow-up, six out of eleven patients who had received only medical treatment, cannot be found; five patients or their relatives were interviewed by phone: two of them enjoyed good health and three had died. S ixteen patients underwent thoracic surgery and one of them died because of postsurgical complications. In the follow-up, only nine patients out of thi s last group were interviewed by phone 2 to 8 years after surgery: seven of them enjoyed good health while two patients had died because of disease no t related to pulmonary mycetoma. Conclusions. Aspergilloma treatment is related to the extension of disease and clinical conditions of patients but surgical resection associated with drug administration, when possible, is the treatment of choice.