Endobronchial Aspergilloma (EBA) - An Enigma in Itself

Abstract

Abstract SESSION TYPE: Infectious Disease Case Report Posters IIPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Endobronchial aspergilloma is a rare disease entity with pulmonary involvement of aspergillus. Definition of this entity is not well described in the literature and is not usually classified with other pulmonary aspergillosis. This is an unusual form of a fungus ball, found inside of the bronchus with or without a parenchymal lesion and/or cavity. Few cases of endobronchial aspergillosis associated with tumors have been reported in the literature.CASE PRESENTATION: A 49 year old, non smoker male with prior history of rectal cancer treated with surgery and chemo-radiation 6 years back and in remission presented with three weeks of dry cough and occasional hemoptysis. Patient was still symptomatic after a course of antibiotics. Chest X ray demonstrated left upper lobe (LUL) infiltrate and Computed Tomography (CT) of chest demonstrated LUL mass with adjoining atelectasis. Bronchoscopy revealed a pearly white lesion in LUL bronchus which was biopsied and pathology was consistent with necrotic tissue with surrounding Aspergillus species without local tissue invasion. CT guided biopsy of LUL mass showed Metastatic Adenocarcinoma positive for rectal tumor markers. Positron Emission Tomography revealed no other metabolically active lesion except the LUL mass. Our patient was treated with itraconazole for 3 months along with chemotherapy with significant improvement in clinical and radiographical findings.DISCUSSION: EBA is a rare disease entity with involvement of Pulmonary bronchus with Aspergillus species. It is hard to differentiate true EBA with colonization of Aspergillus with underlying cancer. 50 % of the patients are immunocompromised. Clinically patient exhibit symptoms of cough, fever, wheezing or hemoptysis. Radiographically, CT chest shows endobronchial lesion with lobar or segmental atelectasis. Bronchoscopy with endobronchial biopsy is diagnostic of EBA. Bronchoscopic findings vary from yellowish-white necrotic material-plaques to whitish nodules. Optimal treatment of EBA has not yet been established. Duration of therapy vary between 1 and 48 months in different case series based on disease severity. Treatment options include Amphotericin B, Voriconazole, Itraconazole or Capsofungin. Invasive procedures including debridement, surgical resection, stent placement and Nd-YAG laser has limited role in literature.CONCLUSIONS: EBA is a rare pulmonary manifestation of Aspergillus species. Treatment of EBA is a challenge since there is limited literature on the ideal duration and type of treatment.1) Endobronchial Aspergilloma: Report of 10 Cases and Literature Review- Yonsei Med J. 2011 September 1; 52(5)2) Endobronchial Aspergilloma in a 30-year-old Man- Journal of Bronchology: July 2007 - Volume 14 - Issue 33) Endobronchial Fungal Disease: An Under-Recognized Entity- Respiration 2007DISCLOSURE: The following authors have nothing to disclose: Aman Sethi, Nitesh Jain, Hasnain Bawaadam, Puja Sethi, Nisha Jain, Fazila Barodawala, Sivashankar SivaramanNo Product/Research Disclosure InformationChicago Medical School/Rosalind Franklin University of Health a Science, North Chicago, IL.