E. Fournier
Oct 1, 1987
Citations
0
Influential Citations
28
Citations
Quality indicators
Journal
Thorax
Abstract
SIR,-I read with interest the report of the trial of ketoconazole in non-invasive pulmonary aspergillosis by Dr DJ Shale and colleagues (January 1987;42:26-3 1). It is the first time that an antifungal agent has proved effective in allergic bronchopulmonary aspergillosis. We were unable to find any benefit from ketoconazole 400 mg/day in an open trial of nine cases of allergic bronchopulmonary aspergillosis.1 All the patients relapsed over the next 12 months: three after two months, two after five months, and four between six and 12 months. Relapse was ascertained on biological criteria in all cases (increase of total serum IgE levels, isolation of Aspergillusfumigatus in sputum), associated in five cases with both clinical (increase of asthma or sputum or both) and radiological criteria (pulmonary infiltration or mucoid impaction with atelectasis or both), with clinical criteria alone in three cases, and radiological criteria alone in one case. Another case of allergic bronchopulmonary aspergillosis can be added to this series. This patient presented with psoriasis complicated by erythroderma after treatment with corticosteroids prescribed for the allergic bronchopulmonary aspergillosis. Corticosteroids were withdrawn and, despite treatment with ketoconazole 400 mg/day for eight months, he developed a left upper lobe eosinophilic infiltrate in the second month and mucoid impaction of the right upper lobe bronchus six months later, with an increase of total serum IgE from 1740 to 7842 and 9764 U/ml on the two occasions. So in our experience ketoconazole was unable to prevent relapse of allergic bronchopulmonary aspergillosis. Our study was an open trial and we focused on relapse of allergic bronchopulmonary aspergillosis and not on asthma symptom scores. Our patients did not receive inhaled corticosteroids but three received 10-15 mg prednisone, the other patients receiving only sympathominetics and/or theophylline. We are interested to know the follow up of the patients studied by Shale et al after ketoconazole was stopped. ERIC C FOURNIER Department de pneumologie Hopital Calmette 59000 Lille, France