Pulmonary aspergillosis with bronchocentric granulomas.

A 56-year-old Japanese man without asthma was admitted with cough, excessive sputum, and abnormalities on the chest X-ray film. The lung biopsy material showed necrotizing granulomas centered upon bronchioles. Serial sections of the material revealed a mass of well-oriented, uniform, viable-appearing aspergillus hyphae in the center of the granulomas. There was no evidence of blood eosinophilia, tissue infiltration of eosinophils, or deposition of immunoglobulins or complement in the granulomatous lesion. Thus, we obtained no direct evidence of an allergic reaction. After treatment with the antifungal drug, 5-flucytosine, the patient is in good health. This may be the first documentation of pulmonary aspergillosis showing predominantly bronchocentric granulomas in a nonasthmatic patient who was not immunocompromised.