Pathophysiological study of chronic necrotizing pulmonary aspergillosis

Area of Science:

• Pulmonology
• Mycology
• Pathology

Background:

• Chronic necrotizing pulmonary aspergillosis (CNPA) is a severe fungal infection.
• Tuberculosis sequelae can predispose individuals to CNPA.

Observation:

• Three CNPA patients with severe hemoptysis and underlying tuberculosis sequelae were studied.
• Clinical presentation included fever, fatigue, hemoptysis, and CT findings of fungus balls and cavities.
• Despite antifungal and corticosteroid treatment, all patients died from respiratory failure.

Findings:

• Histopathology revealed a three-layered cavity wall (necrotic, granulation, fibrous).
• Aspergilli were present in fungus balls and necrotic tissue.
• Cavity wall vessels showed thrombosis, necrosis, and local fungal invasion.

Implications:

• Surgical intervention should be considered for CNPA patients.
• Necrotic and fungus-invaded vessels in CNPA cavities pose a significant risk for massive hemoptysis.