American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for aspergilloma (fungus ball)?

1. Liposomal amphotericin B

2. Voriconazole

3. Itraconazole

4. Fluconazole

The correct answer is: Itraconazole

The recommended treatment for aspergilloma, commonly referred to as a "fungus ball," involves the use of itraconazole. This antifungal medication is effective against Aspergillus species, which are the causative agents of aspergilloma. Itraconazole works by inhibiting the synthesis of ergosterol, a critical component of fungal cell membranes, thereby demonstrating a potent antifungal effect. In patients with pulmonary aspergilloma, itraconazole is often used due to its effectiveness and favorable oral bioavailability, making it suitable for long-term outpatient therapy. This treatment is especially important since surgical intervention might not be feasible for all patients, and itraconazole can help manage the infection and prevent further complications. Other antifungal agents like liposomal amphotericin B, voriconazole, and fluconazole have differing clinical applications and efficacy against Aspergillus species. Liposomal amphotericin B is typically reserved for invasive aspergillosis rather than the treatment of localized disease like aspergilloma. Voriconazole, while used for some forms of aspergillosis, is not the first-line choice for managing an aspergilloma specifically. Fluconazole is not effective against most Aspergillus species, limiting