A Case Series of Chronic Necrotizing Pulmonary Aspergillosis and a New Proposal

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  • Tashiro Takayoshi
    Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences
  • Izumikawa Koichi
    Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences
  • Tashiro Masato
    Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences
  • Morinaga Yoshitomo
    Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • Nakamura Shigeki
    Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences
  • Imamura Yoshifumi
    Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences
  • Miyazaki Taiga
    Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences
  • Kakeya Hiroshi
    Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences
  • Yamamoto Yoshihiro
    Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences
  • Yanagihara Katsunori
    Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • Hayashi Tomayoshi
    Department of Pathology, Nagasaki University School of Medicine
  • Nagayasu Takeshi
    Department of Translational Medical Science, Nagasaki University Graduate School of Biomedical Sciences
  • Kohno Shigeru
    Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences

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Chronic necrotizing pulmonary aspergillosis (CNPA) is an indolent, cavitating process in the lungs resulting from invasion of lung tissue by Aspergillus spp. However, most previous reports have not found any clear evidence of parenchymal invasion, and clinical distinction between CNPA and chronic cavitary pulmonary aspergillosis (CCPA) is difficult. We performed a histopathological study of lung specimens obtained by autopsy, surgical resection, or biopsy to clarify the characteristic pathological and clinical features of CNPA. We present 4 cases of proven CNPA, diagnosed by histological demonstration of tissue invasion by the fungus, and present its clinical features. These 4 patients were male, and the mean age was 62 years (range, 51–75 years). Their underlying conditions were chronic obstructive pulmonary disease (n = 3), sequelae of pulmonary tuberculosis (n = 2), and diabetes mellitus (n = 1). Aspergillus precipitation tests were positive for 3; and Aspergillus antigen tests were positive for 2 on admission, and subsequently, for all 4. The isolated pathogens were Aspergillus niger for 1 and A. fumigatus for 1. Initial radiographic findings were infiltrates or nodular lesions, which slowly progressed and cavitated before the appearance of fungus balls. Although CNPA has characteristic pathological features, it is clinically difficult to distinguish CNPA from CCPA. We propose to use the term chronic progressive pulmonary aspergillosis for both CNPA and CCPA.

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