SOLID ENDOBRONCHIAL ASPERGILLOMA: A RARE ENTITY

Abstract

SESSION TITLE: Fellows Chest Infections Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Aspergillosis refers to disease caused by a fungus of the genus Aspergillus, with the most common species being A. fumigatus. The most commonly affected organs are the lungs. Aspergilloma is a mass more commonly known as a “fungus ball” consisting of fungal hyphae mixed with cellular debris and mucus. An aspergilloma usually forms within cavities in the lungs. It may occur in a person with normal immunity but with structurally abnormal lungs, with preexisting cavities that lead to airflow stasis [1]. Endobronchial aspergilloma (EBA) is a rare presentation of pulmonary aspergillosis with only a handful of reported cases in literature. Here we present a case of endobronchial aspergilloma with significant space occupying and obstructing mass. CASE PRESENTATION: A 57-year-old female with recent history of thrombotic thrombocytopenic purpura that was treated with plasmapheresis and a pertinent medical history of diabetes, COPD and is an active smoker. She was evaluated in the pulmonary office for a cavitary lung lesion and was admitted for further workup including bronchoscopy. CT chest was obtained which did reveal a cavitary lesion in the right upper lobe (Figure 1) and atelectasis of the right middle and lower lobe. She then underwent bronchoscopy, which revealed an obstructing mass in the right bronchus intermedius with abnormal changes in the mucosa distal to the mass (Figure 2). Closer examination revealed some bleeding from around the mass. Multiple biopsies were then obtained revealing abundant septate hyphae consistent with aspergillus. Patient was started intravenous voriconazole and subsequently switched to oral on discharge with plans for repeat follow up bronchoscopy in 6 months. DISCUSSION: EBA is a very rare entity and is typically encountered as an incidental finding on bronchoscopy. It is usually defined as a noninvasive type of aspergillosis. An endobronchial mass the aspergilloma can be mistaken for lung cancer and can also sometimes hide an underlying cancer [2,3]. It can be very easily diagnosed with histopathologic examination of endobronchial mass revealing the fungal elements. Review of literature revealed only a handful of published cases and 1 case series reporting EBA. There are no established treatment guidelines or recommendations for EBA [2]. Pulmonary aspergillosis with cavitary lesions in the parenchyma is treated surgically with limited role of systemic antifungal therapy. However EBA the current consensus seems to be bronchoscopic intervention followed by systemic antifungal therapy [2,3]. Short-term follow up bronchoscopy is recommended to evaluate for response to therapy [2]. CONCLUSIONS: EBA is a rare presentation and usually diagnosed incidentally during bronchoscopy. It can occur in immune competent patients with underlying structural lung disease. Much remains to be learned as the optimal treatment and duration of medical therapy is not yet established. Reference #1: Huang, D., Li B., Chu, H., Et al. Endobronchial Aspergilloma: A Case Report and Literature Review. Experimental and Therapeutic Medicine. 2017;14:547-554 Reference #2: Ma, J., Yun, E., Kim, Y., Et al. Endobronchial Aspergilloma: Report of 10 cases and Literature Review. Yonsei Medical Journal. 2011;52(5):787-792 Reference #3: Araujo, D., Figueiredo, M., Monteiro, P. Endobronchial Aspergilloma: An Unusual Presentation of Pulmonary Aspergillosis. Pulmonology. 2016;22(1):61-62 DISCLOSURES: No relevant relationships by Mohammed Ali, source=Web Response No relevant relationships by Humayun Anjum, source=Web Response No relevant relationships by Aisha Mujahid, source=Web Response No relevant relationships by Salim Surani, source=Web Response No relevant relationships by Abhay Vakil, source=Web Response