Therapeutic approach in pulmonary mycetoma. Analysis of 27 patients

BACKGROUND: Pulmonary mycetoma is a characteristic clinical-radiological lesion due to colonization of aspergillus or candida species in pre-existing pulmonary cavities following a number of diseases. METHODS: We revisited 27 records of such admitted patients (19 M, 8 F; range age 16-27 yrs) analysing diagnostic approach and therapy. Predisposing conditions were sequelae of tuberculosis or lung abscess, bronchiectasis, bullous emphysema, leukaemia/ lymphoma, diabetes mellitus, corticosteroids and/or immunosuppressant administration and antiblastic chemotherapy. All patients had a characteristic chest X-ray and the most common symptoms were cough and haemoptysis. Diagnosis of pulmonary mycetoma was based on positive sputum culture for aspergillus or candida species and/or positive result for aspergillus precipitin test. Eleven patients received only medical treatment, eight pts only a surgical one and eight patients both medical and surgical ones. Antifungal drugs administered were itraconazole or amphotericin B or fluconazole. RESULTS: In the follow-up, six out of eleven patients who had received only medical treatment, cannot be found; five patients or their relatives were interviewed by phone: two of them enjoyed good health and three had died. Sixteen patients underwent thoracic surgery and one of them died because of postsurgical complications. In the follow-up, only nine patients out of this last group were interviewed by phone 2 to 8 years after surgery: seven of them enjoyed good health while two patients had died because of disease not related to pulmonary mycetoma. CONCLUSIONS: Aspergilloma treatment is related to the extension of disease and clinical conditions of patients but surgical resection associated with drug administration, when possible, is the treatment of choice.