Local Administration of H2O2 Reduced Aspergilloma in a Patient with Chronic Granulomatous Disease: A Case Report

Author(s): Toyoki Nishimura, Hideaki Nakamura, Tomoyuki Mizukami, Fumio Hidaka, Makoto Matsukura, Hiroshi Moritake, Hiroyuki Nunoi

Granulomas in patients with chronic granulomatous disease (CGD) are intractable to conventional treatments; they are sometimes inoperable and may even be lethal. A 2-year-old boy with X-linked CGD and a large aspergilloma was treated with an antibiotic and antifungal agent along with steroids and interferon-γ administration for 6 months, but the granuloma did not shrink. Slow local administration of 20-mM hydrogen peroxide to the granuloma lesion through the catheter reduced granuloma size within 1 month. One month later, the remaining aspergilloma was excised by right lower lobectomy. One year later, bone marrow transplantation was successfully performed, followed by two rounds of donor lymphocyte infusion and with rituximab, the latter owing to low chimerism of the donor type with autoantibodies. This case demonstrates the feasibility of local administration of H2O2 for treating granulomas in patients with CGD.