Use of nebulised liposomal amphotericin B in the treatment of Aspergillus fumigatus empyema.

A 28 year old man with asthma, bronchopulmonary aspergillosis, pulmonary thromboembolic disease, and pulmonary hypertension developed Aspergillus fumigatus empyema complicating a pneumothorax. His condition progressively deteriorated despite treatment with intravenous and intrapleural amphotericin B, but improved promptly after substituting nebulised liposomal amphotericin B and oral itraconazole. This experience suggests that nebulised liposomal amphotericin B is well tolerated and merits further assessment in the treatment of pulmonary fungal disease.