Combined intracavitary, systemic antifungal and surgical treatment of Chronic Pulmonary Aspergillosis: experience from an immunocompromised patient.

We present a complex case of Chronic Pulmonary Aspergillosis (CPA) caused by Aspergillus fumigatus in a pre-existing lung cavity in an immunocompromised patient with granulomatosis with polyangiitis. Initial treatment with voriconazole was limited due to adverse effects and emerging azole resistance.Aspergillus Subsequent therapy with intravenous and intracavitary amphotericin B was also poorly tolerated and clinically insufficient. The patient underwent left-sided thoracotomy with decortication. As a novel approach, the patient recieved Post-surgical instillation of liposomal amphotericin B directly into the resected cavity, combined with systemic antifungal therapy. Subsequently the patient recovered with long-term remission. This case highlights the potential role of post-operative intracavitary antifungal instillation as an adjunctive strategy in refractory CPA, particularly when conventional medical therapy fails.2012 Elsevier Ltd. All rights reserved.