Pleural Aspergillosis Complicating Chronic Cavitary Pulmonary Aspergillosis in a Tuberculosis Sequel: About One Case

Abstract

Introduction: Pleural aspergillosis is a rare pathology; it is defined by an infection of the pleural cavity by an opportunistic fungus of the genus Aspergillus. Observation: We report the case of a 24-year-old female patient treated for pulmonary tuberculosis complicated by a left pyopneumothorax drained for 5 months. The reason for consultation 3 months after stopping the antibacillary treatment was a purulent bronchial syndrome, left chest pain with a tingling sensation and exertional dyspnea. Clinical examination revealed an aerated effusion syndrome in the left hemithorax. Chest imaging showed a left pneumothorax with thickening of the visceral pleura and a left upper lobar alveolar focus with clearing within it. Aspergillus serology was positive. The patient had undergone video-assisted thoracoscopy, which revealed the presence of false membranes and whitish deposits of mycotic appearance. The biopsy of the pseudomembranes was in favor of pleural aspergillosis. The patient was put under antifungal treatment for 6 months with a good clinical and radiological evolution. Conclusion: Aspergillus is a mycelial fungus formed by filaments that penetrate the airways by inhalation of its spores. Pleural localizations are rare. Sequelae of tuberculosis, broncho pleural fistulas, pleural drainage and pulmonary resection are considered the main conditions predisposing to infection of the pleural space by aspergillus. The diagnosis is confirmed by pleural fluid culture or pleural biopsy.