English

Abstract

Chronic necrotizing pulmonary aspergillosis or semi-invasive pulmonary aspergillosis is one of the forms of pulmonary aspergillosis typically found in mildly immunocompromised patients. It is an indolent, cavitary and infectious process of the lung parenchyma secondary to local invasion by aspergillus species. We report a case of a male patient aged 55 years with complaints of chronic productive cough with blood tinged sputum, orthopnea, acute episode of hemoptysis and post percutaneous transluminal coronary angioplasty status 6 weeks back. X-ray and computed tomography of the chest revealed consolidation with interposed cavitation in the right upper lobe and pleural thickening. Computed tomography guided fine needle aspiration cytology smears showed aspergillus hyphae with abundant necrotic material and inflammatory cells. Fungal stains were positive for aspergillus. Based on the clinical, radiological and cytological findings, the patient was diagnosed with chronic necrotizing pulmonary aspergillosis and treated successfully with oral itraconazole. In view of difficult diagnosis of chronic necrotizing pulmonary aspergillosis, fine needle aspiration cytology plays important role when biopsy is not possible, contributing to early treatment with systemic antifungal therapy and preventing its morbidity and mortality. Surgery plays a small role in the treatment because of poor overall lung function in many patients.