Chronic necrotizing pulmonary aspergillosis: Pathologic outcome after itraconazole therapy

Objective: To characterize chronic necrotizing pulmonary aspergillosis (CNPA) clinically, radiographically, and pathologically and to describe its response to treatment. Material and Methods: We present three cases of well-documented CNPA and detail the long-term clinical and pathologic responses to the new antifungal triazole, itraconazole. Results: Although all three patients had an appreciable clinical response to itraconazole therapy, tissue obtained at the time of operation or autopsy revealed residual CNPA despite 5 to 12 months of treatment, Even though pathologic resolution of the CNPA did not occur, patient prognosis was determined solely by comorbid illness. Conclusion: Itraconazole seems to be effective in CNPA when used in a suppressive (rather than curative) role in patients with limited life expectancy.