Invasive pulmonary aspergillosis with adenocarcinoma of the lung, serology consistent with ABPA

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A 75 year old woman presented with a persistent dry cough. Her second CT scan of thorax showed lesions in the right and left upper lobes with ill defined consolidation in other areas (see images 3a, 3b and 3c). A PET scan is positive. She underwent right thoracotomy and sub-lobar wedge resection. Aspergillus was grown from tissue and sputum grew Pseudomonas. Histology confirms the nodule to be non-small cell carcinoma (adenocarcinoma) but other lung areas show organizing pneumonia and another abscess formation with a cluster of branching septate hyphae. Despite starting itraconazole and oral ciprofloxacin she deteriorates with Type 1 respiratory failure. She is intubated and ventilated and switched to intravenous voriconazole and ceftazidime. She develops acute renal failure and then Enterococcus faecium bacteremia and she dies 3 days later.


  • Aspergillus fumigatus