Abstract
A 76-year-old man was treated with methotrexate and prednisolone due to joint pain. Due to the presence of colon cancers in June, 2003, he had a laparoscopy assisted deccnding colonectomy (pSMN0M0 stageI), and in August, 2004, he had a sigmoidectomy (pSMN0M0 stageI). In August, 2007, chest CT showed an abnormal 3-cm shadow in the right lung (S3). At that time, his symptoms included hemoptysis, chest pain, and cough. Chronic necrotizing pulmonary aspergillosis (CNPA) was diagnosed. The patient was treated with voriconazole ; the extent of the CNPA decreased, and his symptoms improved. The patient had a right upper lobe resection, and the edge of the right upper bronchus was covered by a flap of latissmus dorsi muscle. On pathology, no findings of aspergillus were found. It is likely that voriconazole treatment caused the aspergillus to become necrotic. In this case, voriconazole was very effective in treating CNPA.
