Percutaneous intracavitary antifungals for a patient with pulmonary aspergilloma; with a special reference to in vivo efficacies and in vitro susceptibility results.

A 61-year-old man with pulmonary aspergilloma received two antifungals intracavitarily. Although clinical, serological and roentgenographic improvement were observed with fluconazole therapy, bronchial secretions continuously yielded Aspergillus fumigatus. When fluconazole was switched to amphotericin B, the pathogen was eradicated immediately. The minimal inhibitory concentrations (MICs) of the isolate were 400 micrograms/ml for fluconazole, and 0.2 microgram/ml for amphotericin B. Although the discrepancy between in vitro and in vivo efficacy of antifungals has been argued, it was suggested the drug of choice should be selected on the basis of the MIC results at least in the intracavitary antifungal therapy for pulmonary aspergilloma.