Invasive pulmonary aspergillosis in chronic granulomatous disease: response to systemic prednisolone treatment and locally applied amphotericin B.

A five-year-old boy with deforming and destructive invasion of pulmonary aspergillosis to the thoracic cage was diagnosed as having chronic granulomatous disease. Conventional antifungal therapy failed in this patient. Prednisolone therapy was added and rapidly improved the general condition of patient but deterioration had already been very rapid. The failure of systemic therapy prompted us to give amphotericin B locally to the granulomatous lesions through the bronchocutaneous fistula. This application yielded a good clinical response with closure of fistula. Despite this improvement the patient died from septicemia. We believe that systemic prednisolone treatment is useless in such cases, but local application of amphotericin B into the granulomatous lesions together with systemic therapy during the earlier stages of infection can contribute to a change in prognosis.