Abstract
A middle aged female presented with symptoms of chronic cough, breathlessness, fatigue and weight loss of 4 months duration. Chest Xray (CXR) was suggestive of bilateral upper lobe mass lesion with a differential diagnosis in favour of malignancy. Contrast enhanced computed tomography (CECT) chest showed collapse of right upper lobe and left upper lobe. Bronchoscopy showed thick gelatinous globular plugs occluding both upper lobes and guided biopsy showed granular necrotic debris and dense eosinophilic infiltrates. Her serum immunoglobulin-E (IgE) levels were very high (18,887 IU/ml) and Gomori Methenamine Silver staining was suggestive of Aspergillus sps. She was diagnosed to have Primary pulmonary aspergillosis and treated with itraconazole for 2 months. She responded very well and lung lesions cleared drastically on follow up.
Highlights
Primary pulmonary aspergillosis usually occurs in the background of a chronic lung disease
Shortness of breath worsened from grade I to grade III Modified Medical Research Council dyspnoea scale (MMRC) over 4 months [1]
Aspergillus fumigatus is the major isolate from such patients [2]
Summary
A middle aged female presented with symptoms of chronic cough, breathlessness, fatigue and weight loss of 4 months duration. Contrast enhanced computed tomography (CECT) chest showed collapse of right upper lobe and left upper lobe. Bronchoscopy showed thick gelatinous globular plugs occluding both upper lobes and guided biopsy showed granular necrotic debris and dense eosinophilic infiltrates. Her serum immunoglobulin-E (IgE) levels were very high (18,887 IU/ml) and Gomori Methenamine Silver staining was suggestive of Aspergillus sps. She was diagnosed to have Primary pulmonary aspergillosis and treated with itraconazole for 2 months. Initial differential diagnosis of malignancy was considered as chest X-ray PA view was showing a right upper lobe mass with golden ‘S’ sign. Contrast enhanced CT (CECT) chest showed complete cut off of right upper lobe bronchus with collapse of both right and left upper lobes and enlarged right paratracheal/ subcarinal lymph nodes (Figure 1)
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