Invasive Pulmonary Aspergillosis Associated with High-Dose Inhaled Fluticasone
To the Editor: A 44-year-old man with moderately severe asthma was first seen in the infectious-disease clinic in November 1999 because of a recent diagnosis of pulmonary aspergillosis. The patient had noted an increase in his asthma symptoms during the summer of 1999. A chest x-ray film obtained at that time had revealed bilateral cavitary lesions. An open-lung biopsy in September 1999 had revealed chronic necrotizing aspergillosis. The patient had no known history of immunosuppression. His medications included fluticasone (delivered in two puffs of 220 μg four times a day [total daily dose, 1760 μg]) and zafirlukast (20 mg per . . .