0 pg/mL, and his Aspergillus galactomannan antigen index was 0.4 at three months after the start of treatment. During the study period, the fibrotic pulmonary cavity enlarged (Figs. 1 and 3), and the patient’s pulmonary function deteriorated in accordance with the progression of his IPF. Chemically-induced bronchitis and drug-induced interstitial lung disease were considered

to be potential side effects of the abovementioned treatment regimen, but neither of these conditions developed. In addition, no L-AMB-related renal dysfunction or hypokalemia were observed. The abovementioned treatment was so effective that the patient’s Y-27632 hemoptysis disappeared within two weeks and his aspergilloma shrank within three months and had completely disappeared within seven months. Aspergillus is a ubiquitous fungus, and all human

beings breath in its conidia during everyday life. However, any conidia that attach to the lower respiratory tract are removed by mucociliary clearance, and those that reach the alveoli are phagocytosed by alveolar macrophages [5]. Furthermore, even when the conidia sprout hyphae they are sterilized by neutrophils [6], resulting in healthy hosts escaping from fungal infection. Aspergillus can cause a variety of diseases depending on both the immunological status of the host and the local condition of the lung http://www.selleckchem.com/products/PLX-4032.html [1] and [2]. Pulmonary aspergillomas usually occur in pre-existing lung cavities exhibiting local immunodeficiency, such as those caused by tuberculosis, bronchiectasis, emphysema, pneumoconiosis, sarcoidosis, and interstitial pneumonia [3]. Pulmonary aspergillomas are classified into simple and complex aspergillomas [7], and the latter type is more prevalent because it is associated

with underlying diseases. Surgery such as cavernostomy with muscle transposition, partial resection, segmentectomy, or lobectomy [9], [10] and [11] Verteporfin cost is recommended as a curative treatment [8]. Although less invasive surgical strategies such as cavernostomy have been developed, underlying diseases can make the optimal surgical procedure very difficult. For those patients who are unsuitable for surgery, amphotericin B (AMPH-B), L-AMB, VRCZ, ITCZ, and micafungin sodium are utilized as systemic antifungal agents because they are effective against invasive aspergillosis and chronic necrotizing pulmonary aspergillosis [12], [13] and [14]; however, there is no evidence from randomized controlled studies to support the use of these drugs against aspergillomas, with some reports suggesting that systemic AMPH-B administration is ineffective [15] and oral ITCZ only achieves limited outcomes [16]. The optimal treatment duration has not been established and varies from several months to years, even in cases in which treatment is effective. The limited response rates of systemic antifungals are due to poor drug delivery to saprophytic fungus balls [4], and severe side effects can sometimes lead to treatment cessation.