Chronic cavitating pulmonary aspergillosis with lung abscess.

DESCRIPTION This is a case of chronic cavitating pulmonary aspergillosis complicated by bacterial infection in a 71-year-old gentleman. He had a history of chronic obstructive pulmonary disease (COPD; severe, Forced expiratory volume in 1 s=0.94) and was treated with Seretide and Tiotropium. Prior to this illness he had a good functional status. He presented with a 1-month history of progressive shortness of breath. Chest radiograph showed a large welldemarcated cavity in the left upper zone (figure 1). Further investigation by CT showed a large 10×10 cm cavitating lesion in the left upper lobe (figure 2). Bronchoscopy and bronchoalveolar lavage were performed and Aspergillus fumigans cultured. He had a positive Aspergillus precipitans with a titre of 1 in 16. Cultures for acid fast bacilli were negative (figure 3). He was successfully treated with a combination of antifungals and antibiotics. The treatment included 13 days of Fungizone 50 mg daily with Piperacillin/Tazobactam