Pulmonary aspergilloma in immunocompromised patients in a Respiratory Care Unit

Pulmonary aspergilloma is commonly associated with comorbidities that cause immunodeficiency such as diabetes mellitus, tuberculosis, human immunodeficiency virus/acquired immunodeficiency syndrome and/or a pre-existing parenchymal lung disease such as chronic obstructive pulmonary disease. Predisposing factors can further increase the risk of acquiring this mycosis. Our objective was to determine the frequency, clinical and microbiological characteristics of pulmonary aspergilloma in immunocompromised patients.

Retrospective case series of patients diagnosed with pulmonary aspergilloma in a respiratory care unit in Mexico City from 2000 to 2019 was studied. Bronchoalveolar lavage cultures on Sabouraud-dextrose agar and serum galactomannan determination were performed on each patient.

We identified twenty-four patients with pulmonary aspergilloma (sixteen male and eight female), thirteen had a history of tuberculosis (54%), seven of diabetes mellitus (29%), three of human immunodeficiency virus/acquired immunodeficiency syndrome (13%) and one of chronic obstructive pulmonary disease (4%). The most commonly reported symptoms were hemoptysis in eighteen patients (75%), dyspnea in sixteen patients (67%) and chest pain in thirteen patients (54%). Aspergillus fumigatus was identified in all cultures and galactomannan was positive in 21 serum samples (87%).

Coexistence of diseases that could suppress the immune system predispose to pulmonary aspergilloma; clinical presentation is often confused with other systemic diseases. A high degree of clinical suspicion is important for early detection.