Sarcoidosis: A Risk Factor for Developing Chronic Pulmonary Aspergillosis

Author:

T. Khan

Author address:

Internal Medicine, Jersey Shore Unversity Medical Center, Neptune, NJ, United States.

Full conference title:

The American Thoracic Society Conference 2018

Date: 19 November 2018

Abstract:

Introduction: Chronic Pulmonary Aspergillosis (CPA) also known as chronic cavitary pulmonary aspergillosis or complex aspergilloma usually affects people with underlying cavitary lung disease. CPA is different from simple aspergilloma as patients are more symptomatic and lung architecture gets worse overtime. Case: A 59 year old female with a history of sarcoidosis and asthma presented with progressive shortness of breath over the last 4 months. She was admitted multiple times in last couple of months with shortness of breath and was treated for asthma exacerbation. During this admission chest X-ray revealed chronic changes consistent with her diagnosis of sarcoidosis. A CT scan of the chest was obtained as her symptoms did not improve after the initial treatment. CT scan revealed multiple cavities with fungal balls, bilateral reticulonodular opacities as well as bilateral lower lobe bronchiectasis. She remained dependent on oxygen during the hospital stay. Patient was treated with intravenous antibiotics, nebulization treatments and intravenous steroids during this visit. Blood cultures came back negative but Aspergillus IgG antibodies were positive. Oxygen supplementation was titrated gradually and patient was sent to the rehabilitation facility on oxygen. Patient was advised to follow up in office. Discussion: The diagnostic criteria for CPA is lung cavity or cavities with or without fungal balls, constitutional or respiratory symptoms lasting three months and a positive Aspergillus IgG with or without culture of Aspergillus species from the lungs. CPA usually has a gradual onset and presents with chronic productive cough, weight loss, mild hemoptysis, dyspnea, and fatigue. Although, the diagnosis of CPA may be suspected with a single chest radiograph, sequential chest radiographs are typically required to confirm the progressive nature of CPA lesions. New cavity formation and expansion of pre-existing cavities are characteristic of CPA. Defects in mucociliary clearance associated with structural lung disease appears to be a critical factor in the pathogenesis of CPA. Prior mycobacterial lung infection, COPD, asthma, sarcoidosis, and lung cancer have been described as predisposing conditions. CPA requires prolonged treatment with systemic antifungal agents. Patients with CPA have received treatment with oral itraconazole and voriconazole, whereas IV Amphoterecin B Deoxycolate has been successfully used in refractory cases. Antifungal antibodies and inflammatory markers should be checked every 3 months and chest X-ray every 6 to 12 months to monitor the response. Whereas all symptomatic patients require treatment, only asymptomatic patients with radiographically and serologically stable disease over many months, do not require therapy.

Abstract Number: A5422 / P1200

Conference Year: 2018

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