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Chronic necrotizing pulmonary aspergillosis is not common and usually involves mildly immunosuppressed patients. We present a case of a 58-year-old man with a history of mining-related pneumoconiosis and corticosteroid therapy who developed bilateral pulmonary infiltrates and subsequent cavitation. The patient was treated at first as having community-acquired pneumonia and was only belatedly diagnosed as suffering from aspergillosis after Aspergillus fumigatus precipitins appeared in blood and the same fungus grew from bronchoalveolar lavage fluid. A transthoracic needle biopsy revealed fungal filaments present in material extracted from a pulmonary lesion that was visible on scans. Treatment with amphotericin B, begun at the time that aspergillosis was diagnosed, proved to be ineffective, as was a later change to amphotericin B lipid complex. The diagnosis was confirmed at necropsy.

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single initial empirical antibiotic whereas 92% received combination antibiotics. A total of 122 patients received appropriate initial empirical therapy on the first day of hospitalisation: 9.4% of patients received broad spectrum antibiotics that were not warranted. Eighty-one (58.7%) of the patients had a change in antimicrobial regimen during hospital admission. Overall appropriateness of CAP management based on the composite of initial empirical treatment, duration of treatment and switching antibiotics according to culture and sensitivity during the admission period was 58.0%. Severe respiratory illness was the most significant independent risk factor. Conclusion and relevance The study showed that adherence to CAP guidelines for an initial empirical therapy on the first day of hospitalisation was optimal whereas overall adherence to CAP management throughout the hospital stay was low.