[Invasive pulmonary aspergillosis in a patient with acute leukemia--the role of neutrophil elastase in in cavity formation].

A 47-year-old man complaining of common cold-like symptoms was admitted to our hospital. Acute myelogenous leukemia was diagnosed and the patient was treated with induction chemotherapy. During granulocytopenia caused by induction chemotherapy, a nodular lesion appeared in the right upper lobe. The nodular lesion changed to a cavitary lesion after the recovery of peripheral white blood cell counts. A transbronchial biopsy specimen obtained from the right B3b showed Aspergillus. Oral itraconozole, flucytosine, and intravenous amphotericin B were given. The cavitary lesion in the right upper lobe regressed after anti-fungal therapy was started. During granulocytopenia caused by consolidation chemotherapy, the nodular lesion enlarged again. Thereafter, as bone marrow recovered, it changed to a cavitary lesion with a lung ball inside. In both episodes, a nodular lesion appeared during granulocytopenia, and changed to a cavitary lesion after bone marrow recovery. In addition, the level of neutrophil elastase reached its maximum at the time of the bone marrow recovery. These findings suggest that white blood cells of the host as well as neutrophil elastase play an important role in cavitation in pulmonary aspergillosis.