A case of pulmonary semi-invasive aspergillosis developing fatal acute exacerbation

A 80-year-old male was referred for detailed examination of left apical fibrotic changes in the chest radiograph. Six years later, several cavitary lesions with thickening of the pleura developed. Anti tuberculosis therapy had no effects. Despite intravenous administration of antibiotics, the cavities became larger and the infiltrates progressed to the left lower lobe. The air crescent was observed in one of the cavities. Repeated sputum examinations revealed Aspergillus niger only. With administration of anti fungal drug, infiltrates were faded. Four months after the cessation of antifungal drug high fever associated with new infiltrates developed. Sputum culture showed Aspergillus flavus. Infiltrates over the entire left lung field and in the right upper lobe were observed. On CT film necrotic lung tissue was strongly suggested in the cavity. The patients died of respiratory failure. Although initial course of the presented case was compatible with semi-invasive pulmonary aspergillosis (SIPA), fluminant and fatal exacerbations which may be very unusual in SIPA, developed in later. The mycetoma-like ball may be occasionally made of necrotic lung parenchyma instead of fungal mycelia in SIPA.