Corticosteroid treatment as a risk factor for invasive aspergillosis in patients with lung disease

• Published in: Thorax Vol. 46; no. 1; pp. 15 - 20
• Main Authors: Palmer, L. B., Greenberg, H. E., Schiff, M. J.
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 01.01.1991; BMJ; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Aspergillosis - chemically induced; Aspergillosis - diagnostic imaging; Aspergillosis - microbiology; Aspergillus - isolation & purification; Biological and medical sciences; Dexamethasone - adverse effects; Drug toxicity and drugs side effects treatment; Female; Humans; Lung Diseases - complications; Lung Diseases - drug therapy; Lung Diseases, Fungal - chemically induced; Lung Diseases, Fungal - diagnostic imaging; Lung Diseases, Fungal - microbiology; Male; Medical sciences; Middle Aged; Miscellaneous (drug allergy, mutagens, teratogens...); Pharmacology. Drug treatments; Prednisone - adverse effects; Radiography; Risk Factors; Human; Corticosteroid; Immunopathology; Mycosis; Sarcoidosis; Respiratory disease; Toxicity; Lung; Malignant tumor; Bronchopulmonary; Infection; Chemotherapy; Immunosuppression; Treatment; Aspergillosis; Risk factor; Systemic disease; Tumor; Obstructive pulmonary disease
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thx.46.1.15

Invasive pulmonary aspergillosis usually occurs in severely immunocompromised or neutropenic patients. Six patients with invasive aspergillosis are described whose only defence impairment was underlying lung disease and corticosteroid treatment. Cough, fever, and sputum production were the usual reasons for presentation and four patients developed the sepsis syndrome. Radiographic findings included de novo cavitation in three patients and rapid radiographic progression in four. Aspergillus species were isolated from respiratory secretions of all patients early in the course of the disease. Treatment was effective in only two patients and the subsequent progress of the others was consistent with a chronic necrotising process. Invasive pulmonary aspergillosis is uncommon in patients with respiratory diseases receiving corticosteroids, but should be considered when pneumonia and cavitary infiltrates occur.