Abstract
IntroductionChronic necrotizing pulmonary aspergillosis usually occurs in mildly immune-compromised hosts or those with underlying pulmonary disease. The radiographic pattern of chronic necrotizing pulmonary aspergillosis is typically a progressive upper lobe cavitary infiltrate with pleural thickening. We report here an atypical case of chronic necrotizing pulmonary aspergillosis mimicking lung cancer, which developed into a disseminated fatal disease in an older woman with no comorbidity.Case presentationAn 80-year-old Japanese woman was referred to our hospital for a chest roentgenogram abnormality. Repeated fiber-optic bronchoscopy could not confirm any definite diagnosis, and she refused further examinations. Considering the roentgenogram findings and her age, she was followed-up as a suspected case of lung cancer without any treatment. Then, 10 months later, she complained of visual disturbance and was admitted to our department of ophthalmology. She was diagnosed as having endophthalmitis. After treatment with corticosteroids for 20 days, she developed acute encephalitis and died four weeks later. Autopsy revealed dissemination of Aspergillus hyphae throughout her body, including her brain.ConclusionsIn older patients, even if they do not have any comorbidity, chronic necrotizing pulmonary aspergillosis should be added to the differential diagnosis of solitary pulmonary lesions in a chest roentgenogram.
Highlights
Chronic necrotizing pulmonary aspergillosis usually occurs in mildly immune-compromised hosts or those with underlying pulmonary disease
In older patients, even if they do not have any comorbidity, chronic necrotizing pulmonary aspergillosis should be added to the differential diagnosis of solitary pulmonary lesions in a chest roentgenogram
Aspergilloma occurs in patients with lung cavities, chronic necrotizing pulmonary aspergillosis (CNPA) occurs in those who are mildly immunocompromised and invasive pulmonary aspergillosis is seen in patients who are immunocompromised, such as those with leukemia
Summary
Aspergillus causes a variety of clinical syndromes in the lung, such as aspergilloma, chronic necrotizing pulmonary aspergillosis (CNPA), invasive pulmonary aspergillosis and allergic bronchopulmonary aspergillosis [1]. Case presentation An 80-year-old Japanese woman, without any relevant medical history, was referred to our hospital for a chest roentgenogram abnormality Her chest roentgenogram and computed tomography (CT) results revealed tumor-like shadows, one of which was 35mm in diameter with a clear margin (Figure 1). The endobronchial biopsy specimen could not confirm any definite diagnosis Owing to her age, further aggressive examination was not performed and she was followed-up as having suspected lung cancer. At 20 days after admission, she developed acute encephalitis and was transferred to our department Her serum level of βD glucan was high (1184pg/mL) and a test result for Figure 2 Positron emission tomography (PET) imaging showing the uptake of FDG at the lower and upper lesions in the left lung. Treatment of CNPA are important for a better outcome
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