38 38 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 1 Feb CT A B A CT B 20xx 2 8 LAM 20xx 1 12 CT S6, S10 Aspergillus spp. Micafungin MCFG 150 mg/ I

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1 Feb THE JAPANESE JOURNAL OF ANTIBIOTICS Liposomal amphotericin B Lymphangioleiomyomatosis: LAM 2 20xx 1 CT Aspergillus spp. Micafungin MCFG Itraconazole ITCZ MCFG ITCZ 20xx 6 CT Aspergillus spp. Aspergillus spp. ITCZ MCFG Liposomal amphotericin B L-AMB ITCZ Amphotericin B deoxycholate D-AMB L-AMB 1 Liposomal amphotericin B L-AMB Lymphangioleiomyomatosis LAM

2 38 38 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 1 Feb CT A B A CT B 20xx 2 8 LAM 20xx 1 12 CT S6, S10 Aspergillus spp. Micafungin MCFG 150 mg/ Itraconazole ITCZ 200 mg/ ITCZ 20xx 5 20xx 6 7 CT 1A Aspergillus spp. Aspergillus spp. 1B 6 16 ITCZ MCFG 150 mg/ MCFG L-AMB 7 6 MONFORTE 2 L-AMB 50 mg 12 ml 1 6 ml UN-511

3 Feb THE JAPANESE JOURNAL OF ANTIBIOTICS CT A B A CT B 3. UN CT 2AB 7 27 L-AMB Amphotericin B deoxycholate D-AMB

4 40 40 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 1 Feb D-AMB 50 mg 50 ml 1 6 ml ITCZ D-AMB 4 Aspergillus spp. 90% 500 l Chronic obstructive pulmonary disease COPD 4 6 LAM 7 ITCZ MCFG L-AMB L-AMB D-AMB D-AMB L-AMB Surfactant 8 L-AMB L-AMB D-AMB 9

5 Feb THE JAPANESE JOURNAL OF ANTIBIOTICS L-AMB 14 2 MONFORTE 104 L-AMB 50 mg 12 ml ml ml ml % D-AMB 50 mg 50 ml ml ml % D-AMB 15% D-AMB 10 L-AMB L-AMB MCFG ITCZ D-AMB Surfactant CORCORAN Lipid complex amphotericin B AMPH-B 3.7 m 11 L-AMB D-AMB 2.43, 1.38 m 12 Voriconazole VRCZ L-AMB L-AMB 1 SEGAL, B. H. & T. J. WALSH: Current approaches to diagnosis and treatment of invasive aspergillosis. Am. J. Respir. Crit. Care Med. 173: , MONFORTE, V.; P. USSETTI, R. LÓPEZ, et al.: Nebulized liposomal amphotericin B prophylaxis for Aspergillus infection in lung transplantation: pharmacokinetics and safety. J. Heart Lung Transplant.: , HARRISON s Principles of Internal Medicine 16th ed. 4 ALI, Z. A.; A. A. ALI, M. E. TEMPEST, et al.: Invasive pulmonary aspergillosis complicating chronic obstructive pulmonary disease in an immunocompetent patient. J. Postgrad. Med.

6 42 42 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 1 Feb : 78 80, ADER, F.; S. NSEIR, R. LE BERRE, et al.: Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease: an emerging fungal pathogen. Clin. Microbiol. Infect. 11: , MUQUIM, A.; S. DIAL & D. MENZIES: Invasive aspergillosis in patients with chronic obstructive pulmonary diseases. Can. Respir. J. 12: , FUJITA, M.; Y. TAO, A. KAJIKI, et al.: The clinical ef cacy and safety of micafungin-itraconazole combination therapy in patients with pulmonary aspergilloma. J. Infect. Chemother. 18: , RUIJGROK, E. J.; A. G. VULTO & E. W. VAN ETTEN: Ef cacy of aerosolized amphotericin B deoxycholate and liposomal amphotericin B in the treatment of invasive pulmonary aspergillosis in severely immunocompromised rats. J. Antimicrob. Chemother. 48: 89 95, GAVALDÀ, J.; M. T. MARTÍN, P. LÓPEZ, et al.: Ef cacy of nebulized liposomal amphotericin B in treatment of experimental pulmonary aspergillosis. Antimicrob. Agents Chemother. 49: , MONFORTE, V.; P. USSETTI, J. GAVALDÀ, et al.: Feasibility, tolerability, and outcomes of nebulized liposomal amphotericin B for Aspergillus infection prevention in lung transplantation. J. Heart Lung Transplant. 29: , CORCORAN, T. E.; R. VENKATARAMANAN, K. M. MIHELC, et al.: Aerosol deposition of lipid complex amphotericin-b Abelcet in lung transplant recipients. Am. J. Transplant. 6: , RUIJGROK, E. J.; M. H. FENS, I. A. BAKKER- WOUDENBERG, et al.: Nebulization of four commercially available amphotericin B formulations in persistently granulocytopenic rats with invasive pulmonary aspergillosis: evidence for long-term biological activity. J. Pharm. Pharmacol. 57: , 2005

7 Feb THE JAPANESE JOURNAL OF ANTIBIOTICS CASE REPORT A case report of pulmonary aspergillosis in lung transplant recipient successfully treated with inhalation administration of liposomal amphotericin B MASAKI FUJITA 1, JUN YANAGISAWA 2, MASAFUMI HIRATSUKA 2, TAKESHI SHIRAISHI 2, RYOSUKE HIRANO 1, TAKEMASA MATSUMOTO 1, MOTOKIMI SHIRAISHI 1, AKINORI IWASAKI 2 and KENTARO WATANABE 1 1 Department of Respiratory Medicine, Fukuoka University, Hospital 2 Department of Thoracic Endocrine and Pediatric Surgery, Fukuoka University We report a case of pulmonary aspergillosis in lung transplant recipient who was successfully treated with inhalation administration of anti-fungal agent. The case was 33-year-old female. Two years ago, she had received lung transplant because of lymphangioleiomyomatosis. One year ago, she had diagnosed of pulmonary aspergillosis and successfully treated with micafungin and itraconazole. Then she had been continuous administered with itraconazole. In June 20xx, she had nausea and vomiting and was diagnosed of viral enteritis. Although abdominal symptoms were relieved, ground glass opacity was discovered in her right lung. Bronchoscopic examination revealed ulceration of bronchus with white necrotic substance. Laboratory culture test demonstrated Aspergillus spp. Finally she was diagnosed of recurrent pulmonary aspergillosis. First, she was treated with intravascular administration of micafungin. Then, inhalation administration of liposomal amphotericin B was changed. Ground glass opacity and bronchial region of pulmonary aspergillosis was improved. Thereafter, inhalation of amphotericin B was continued and no recurrence of pulmonary aspergillosis has been found. Inhalation of anti-fungal agent could be an option for pulmonary aspergillosis.

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