Submitted by: Michael on: 16 April 2013
Case number: 8
A 54 year old smoker, with a past history of alcohol abuse had history of left upper lobe pulmonary tuberculosis due to Mycobacterium kansasii diagnosed in August 1993. He was treated with rifampicin and ethambutol until May 1994 but a large cavity remained. In March 1994 he presented with a 3 week history of increased dyspnoea, productive cough with purulent green sputum, left sided chest pain, night sweats and weight loss. Investigations and lung biopsy showed no acid fast bacilli (AFB) or neoplasia. A chest radiograph scan showed 2 cavities in the left upper lobe with thick walls and a rounded shadow at the base of the largest cavity, consistent with an aspergilloma. The largest cavity measured 65cm2. Sputum cultures were positive for A. fumigatus. He was treated with a reducing course of prednisolone for 6 months and itraconazole for 5 months. The cavity size reduced and the aspergilloma became less visible. Despite treatment, his general condition remained poor and he also experienced frequent episodes of mild to moderate haemoptysis.
Keywords:aspergilloma, CCPA, Aspergillus fumigatus, cavity, amphotericin B, G-CSF.
Species (if applicable): Aspergillus fumigatus