Primary Pulmonary Aspergillosis Evolving into Chronic Cavitary Pulmonary Aspergillosis - in the context of Alcoholism

Case number: 

6

Summary: 

A 67 year old man presented with moderate chest pain, cough and fever. A plain chest radiograph revealed left upper lobe consolidation. He was treated with antibiotics with limited response and the fever continued. Five days later the consolidation had expanded with multiple small cavities, reminiscent of tuberculosis. Extensive cavitation was noted and over the next 3 days it increased in size with coalescence of the cavities. Chest X rays and CT scans can be viewed here. Fever, cough and chest pain had diminished but were still present. His past medical history revealed a mild degree of smoking related emphysema. He also gave a history of heavy alcohol abuse in the past, his liver function tests however were normal. Cultures for tuberculosis, Aspergillus, Histoplasma, viruses and bacteria were negative.