What is it about?
A fungus ball (mycetoma or aspergilloma) is a mass of fungi, usually Aspergillus, that grows inside a lung cavity. Surgery is the definitive treatment but carries high risks and is sometimes impossible. We describe a patient with a normal immune system who had multiple fungus balls in both lungs, suggestive of chronic aspergillosis, and could not undergo surgery. He was treated with oral voriconazole for a long period and showed remarkable clinical and radiological improvement after three months.
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Why is it important?
Evidence on how to manage pulmonary fungus balls comes mainly from case reports and uncontrolled studies. This case suggests that long-term oral voriconazole can be a valid option for patients who cannot be operated on, offering a less invasive alternative.
Perspectives
Cases like this remind me that guidelines cannot cover every patient. When the standard option is not feasible, careful clinical reasoning and close follow-up can still lead to an excellent outcome.
Professor Stefano Di Bella
Universita degli Studi di Trieste
Read the Original
This page is a summary of: Multiple Bilateral Pulmonary “Fungus Balls” in an Immunocompetent Patient Unsuitable for Surgical Treatment: Efficacy of Azoles Treatment, Mycopathologia, March 2013, Springer Science + Business Media,
DOI: 10.1007/s11046-013-9639-y.
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