Semi-invasive pulmonary aspergillosis in an immunosuppressed patient: a case report

Fernanda C Cabral,Claudia M Mano,Tatiana C Takayassu,Edson Marchiori,Gláucia Zanetti

doi:10.1186/1757-1626-2-40

Fernanda C Cabral, Claudia M Mano + Show 3 more

Open Access

https://doi.org/10.1186/1757-1626-2-40

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Abstract

BackgroundThe authors present the high-resolution computed tomography findings of an immunosuppressed patient with semi-invasive pulmonary aspergillosis.Case presentationThe main finding consisted of irregular, thick-walled cavity in the right upper lobe and a mass with soft-tissue attenuation within it and thickening of adjacent pleura. Additional findings were bronchial wall thickening associated with a 'tree-in-bud' pattern. Following the clinical, laboratorial and imaging criteria, the diagnosis of semi-invasive pulmonary aspergillosis was defined and antifungical treatment was introduced.ConclusionThe patient responded well to the treatment with improvement in his systemic symptoms and regression of the pulmonary lesions.

Highlights

The authors present the high-resolution computed tomography findings of an immunosuppressed patient with semi-invasive pulmonary aspergillosis.Case presentation: The main finding consisted of irregular, thick-walled cavity in the right upper lobe and a mass with soft-tissue attenuation within it and thickening of adjacent pleura
Pulmonary aspergilosis can be subdivided into five categories: saprophytic aspergillosis, hypersensitivity reaction, semi-invasive aspergillosis, airway-invasive aspergillosis, and angioinvasive aspergillosis [2]
Semi-invasive aspergillosis, known as chronic necrotizing aspergillosis (CPNA) is a chronic form, in which the fungus is intermediate between a simple saprophyte and an invasive pathogen [3]

Summary

Background

Aspergillus is a saprophytic, aerobic fungus that develops on dead or decaying organic matter and produces airborne spores that can be inhaled by man [1]. A 24-year-old black man, presented with an one-month history of productive cough, weight loss and malaise He was diagnosed to have systemic lupus erythematosus 6 years ago and he had pulmonary tuberculosis 4 years ago and for this he received one year of antituberculosis treatment. This disease is characterized by the presence of tissue necrosis and granulomatous inflammation [2] The development of this form of aspergillosis depends largely on the immune status of the patient and the presence of superimposed structural lung disease; so risk factors include: diabetes mellitus, chronic debilitating illness, alcoholism, advanced age, prolonged corticosteroid therapy, chronic obstructive pulmonary disease, sarcoidosis, a history of pulmonary tuberculosis, previous resectional surgery, pneumoconiosis, collagen vascular disease, previous radiation therapy and malnutrition. The patient responded well to the treatment with improvement in his systemic symptoms and regression of the pulmonary lesions (Figure 2C and 2D)

Discussion

Gefter WB