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Diagnostic dilemma: aspergillosis.

K Kothari¹, V Singh, R Sharma

¹Department of Medicine, SMS Medical College, Jaipur.

The Journal of the Association of Physicians of India

|March 29, 2001

Summary

This study reports two Aspergillosis cases, highlighting Allergic Bronchopulmonary Aspergillosis (ABPA) and invasive forms. Early diagnosis and treatment, including steroids and Itraconazole, are crucial for managing these fungal lung infections.

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Area of Science:

Medical Mycology
Pulmonology
Infectious Diseases

Background:

Aspergillosis presents diverse clinical forms, often mimicking other respiratory conditions.
Accurate diagnosis is challenging due to non-specific clinical and radiological features.
Fungal lung infections require consideration in differential diagnoses of various pulmonary diseases.

Observation:

Case 1: A patient with asthma developed Allergic Bronchopulmonary Aspergillosis (ABPA) with high eosinophils and fleeting infiltrates, responding to steroids and Itraconazole.
Case 2: A known ABPA patient on long-term steroids presented with subacute myelitis, suspected to be invasive aspergillosis confirmed by sputum cultures and MRI.
Aspergillus fumigatus was identified in both cases, emphasizing its role in pulmonary disease.

Findings:

Allergic Bronchopulmonary Aspergillosis (ABPA) diagnosis was supported by clinical history, eosinophilia, pulmonary infiltrates, and Aspergillus fumigatus.
Invasive aspergillosis was suspected in an immunocompromised patient with neurological symptoms and confirmed by repeated positive sputum cultures.
The study underscores the diagnostic difficulty of pulmonary aspergillosis due to overlapping symptoms with tuberculosis, pneumonia, and asthma.

Implications:

Early recognition and appropriate antifungal therapy are vital for improving outcomes in Aspergillosis patients.
Considering invasive fungal infections in immunocompromised individuals with atypical presentations is critical.
This research highlights the need for increased awareness of varied Aspergillosis presentations in clinical practice.

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