Le signe du halo et l’aspergillose pulmonaire angio-invasive

Abstract

We here report the case of a 52-year-old man, admitted to the emergency room with fever, persistent cough and hemoptysis evolving over a month. The patient reported no past medical history or specific treatment. There was no evidence of tuberculosis infection. He had consulted a month before with the same symptoms. Chest X-ray had showed right upper lobe pneumonia. The search for tubercular bacilli in sputum was negative. Probabilistic antibiotic treatment was started without success. At the time of admission, febricle not exceeding 38°C and respiratory rate 38 breaths/minute were reported. Crackling sounds in right upper lobe of the lung were heard. Laboratory tests showed neutropenia 410/µl and inflammatory syndrome with CRP levels 112.4 mg/l. VIH serology was negative. Given the persistence of symptoms despite antibiotic treatment, chest CT scan was performed, which showed right apical hyperdense nodule measuring 18x21 mm surrounded by a hyperdense ground glass area, producing a halo sign. No hilar or mediastinal adenomegaly was reported. Left lung was normal. Analysis in the bronchoalveolar lavage fluid (LBA) performed 3 days later showed the presence of septate mycelial filaments on direct examination. The diagnosis of angio-invasive pulmonary aspergillosis was based on these findings. Patient’s outcome was unfavorable, following the appearance of hemoptysis of great abundance and respiratory distress. The patient died 12 hours after bronchoalveolar lavage (BAL).