Abstract
Thirty two year-old male, immunocompetent patient was admitted to the hospital with complaints of cough, dyspnea, nocturnal fever and anorexia. The chest radiography and computerized tomography revealed a mass lesion with adjacent parenchymal infiltrations suggesting lung cancer of the right lower lobe, initially. Bronchoscopy demonstrated the presence of an intraluminal mucoid mass in superior segmental bronchial orifice at the right lower lobe. Histopathological examination of the biopsies from this mass revealed Aspergillus amidst a background of inflammatory exudate rich in eosinophils and Charcot-Leyden crystals with the use of special histochemical stains. Voriconazole at a dose of 6 mg/kg/day in the first day of treatment and maintained as 4 mg/kg/day in the subsequent days resulted in complete resolution in three weeks.
Highlights
Infections caused by Aspergillus sp. in the lung can be divided into three forms: invasive, saprophytic and allergic (Ritter and Krigman, 2008; Katzenstein, 2006; Kim et al, 2010; Zmeili and Soubani, 2007)
Relatively indolent conditions addressed as mucoid impaction of bronchi (MIB) with Aspergillus may be difficult to diagnose and may mimick a mass lesion giving an impression of lung cancer and differential diagnosis is of vital importance
Presentations of Aspergillus related invasive lesions may be as pneumonia, necrotizing tracheobronchitis, necrotizing granulomatous inflammation, and chronic necrotizing aspergillosis
Summary
Hilal Ermis1*, MD, Muhammet Reha Celik, MD, Gazi Gulbas, MD, Deniz Tavli, MD, Zeynep Ayfer Aytemur, MD and N. Thirty two year-old male, immunocompetent patient was admitted to the hospital with complaints of cough, dyspnea, nocturnal fever and anorexia. The chest radiography and computerized tomography revealed a mass lesion with adjacent parenchymal infiltrations suggesting lung cancer of the right lower lobe, initially. Bronchoscopy demonstrated the presence of an intraluminal mucoid mass in superior segmental bronchial orifice at the right lower lobe. Histopathological examination of the biopsies from this mass revealed Aspergillus amidst a background of inflammatory exudate rich in eosinophils and Charcot-Leyden crystals with the use of special histochemical stains. Voriconazole at a dose of 6 mg/kg/day in the first day of treatment and maintained as 4 mg/kg/day in the subsequent days resulted in complete resolution in three weeks
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