Chronic fibrosing pulmonary aspergillosis: A case report

Author:

Temitope V. Fapohunda1, Olufemi T. Ojo 1,2, Ibrahim O. Odulate3, Abiola. A. Omolayole1, Olufunke O. Adeyeye1,2, Emmanuel O. bandele1

Author address:

1. Respiratory unit, Department of Medicine, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria. 2. Department of Medicine, Lagos State University College of Medicine (LASUCOM), Ikeja, Lagos, Nigeria. 3. Department of Medical Microbiology, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria.

Abstract:

Objectives
Aspergillus species are saprophytic fungal organisms that are known to commonly cause infections in individuals with chronic lung diseases such as post-primary TB, COPD and in those who are immunosuppressed. Here we have presented a case of chronic pulmonary aspergillosis occurring in an individual with post-primary TB.
Methods
34 year old female an office cleaner who presented to the respiratory clinic two with complaints of recurrent cough of 1 year duration. Cough is moderately severe and productive of small quantities of mucoid sputum with no associated hemoptysis. She had no other respiratory, cardiac or systemic symptoms. She was treated for smear positive pulmonary tuberculosis (PTB) in 2015. She had no medical co-morbidities. Examination revealed respiratory rate of 20 breaths per minute, oxygen saturation of 96%, bilateral apical flattening, and bronchial breath sounds in the upper lung zones. Examination of the skin, cardiovascular, abdominal and nervous systems yielded no further information.
Available results at presentation: CXR- in-homogenous opacities in both lung fields (sparing the left lower lobe) with fibrotic streaks in both upper lung fields, sputum for acid fast bacilli AFB and gene Xpert- were negative for mycobacilli, erythrocyte sedimentation rate (ESR) was elevated at 59mm in the 1st hour.
Clinical impression of Post-TB lung disease (bronchiectasis and fibrosis) to exclude reactivated PTB, superimposed NMTB and Aspergillus lung disease was made

Further diagnostic evaluation: Chest computed tomography (CT) scan showed a soft tissue mass within a cavity in the left apical region, adjacent bronchial dilatation and traction bronchiectasis with similar changes noted in the right upper lobe, associated fibrotic streaks with diaphragmatic tenting in both lower lobes, and the conclusion was bilateral post-primary PTB changes with superimpose aspergilloma. Serum Aspergillus Ig G antibody levels was elevated at 171 iu/ml (normal range < 20 iu/ml), sputum bacterial, mycobacterial and fungal cultures - yielded no growth. Results Post-TB lung disease complicated with chronic fibrosing pulmonary aspergillosis and aspergilloma. She was placed on oral itraconazole and inhaled bronchodilators, has received pneumococcal and influenza vaccinations, has been reviewed by cardiothoracic who has scheduled her to have extra-anatomical left lung pneumonectomy as definitive therapy for the left lung aspergilloma and fibrosis. She was last seen at the respiratory clinic one month ago, and her cough has markedly improved in severity, now mild, occasional and no longer productive. Conclusion As seen in the case presented, chronic pulmonary aspergillosis is a common cause of post-TB lung disease, it has effective pharmacotherapeutic options with favorable treatment outcomes with early diagnosis and prompt initiation of treatment.

Abstract Number: 21

Conference Year: 2024

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