Abstract
The fungus Aspergillus spp. causes infections in immunocompromised hosts and produces a variety of clinical syndromes including lung tracheobronchial, chronic necrotizing or cavitary pulmonary and allergic bronchopulmonary manifestations, as well as aspergilloma, depending on the type of host-fungus relationship involved. Aspergilloma is usually colonized by Aspergillus spp. lesions in the bronchial tree, while invasive or semi-invasive forms are characterized by the presence of hyphae below its basement membrane. The objective of the present study was to describe the case of a patient with chronic pulmonary aspergillosis in the form of cavitary lesions of lung with infiltrates complicated by pleural empyema, including the clinical course, diagnostic approach and paraclinical care provided. The patient was a 28-year-old female with a history of thymoma who initially presented with febrile and pneumonia 12 years after surgical treatment of tumor. Traditional antibiotic treatment to pneumonia provided no improvement in the patient’s condition and computed tomography of the thorax revealed cavities of destruction and pulmonary opacities. Later a bronchopleural fistula (BPF) was formed. A pleura lesion biopsy was performed after Video assisted thorascopic surgery (VATS) revision of pleural cavity showed a white exophytic lesion and pathological changes of pleura. Since pathologic examination revealed numerous septate fungal hyphae exhibiting 45° branching compatible with Aspergillus spp., the patient was treated with voriconazole. We emphasized on the reasons of delay of true diagnosis due to mistakes in management and treatment of clinical syndromes for a long time. In patients with tumor pathology in anamnesis who present with febrile and respiratory symptoms, it is essential to consider fungi as potential etiologic agents including Aspergillus spp., which is common and causes a variety of clinical syndromes.
Highlights
Aspergillus is a fungus which is commonly found in the soil, spores may germinate into hyphae, which in turn can invade food, plant debris, and indoor environment
The spores are the mucosa leading to beginning of pulmonary aspergillosis aerosolized and inhaled
The type and severity of aspergillosis is determined by the characteristics of the patient [3]
Summary
Aspergillus is a fungus which is commonly found in the soil, spores may germinate into hyphae, which in turn can invade food, plant debris, and indoor environment. The spores are the mucosa leading to beginning of pulmonary aspergillosis aerosolized and inhaled. Both innate immune responses and inflammatory cells. Iryna Liskina et al.: Unusual Specific Lesion of Pleura as Result of Delay in Diagnosis of Chronic. Pulmonary Aspergillosis: A Case Presentation limit fungal growth and prevent disease in the majority of individuals. Depending on host’s immune status and specific immunodeficiencies, Aspergillus may lead to different pulmonary manifestations [1, 2]. Several clinical pulmonary forms have been described, the most important of which are invasive pulmonary aspergillosis (IPA), chronic aspergillosis, and aspergilloma. The type and severity of aspergillosis is determined by the characteristics of the patient [3]
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