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A Case of Invasive Pulmonary Aspergillosis vs. Pulmonary Aspergilloma in Immunocompromised Patient With Preexisting
John Pueringer1, Philip Stephens2, Nirzari K Pandya2
1Internal Medicine, Philadelphia College of Osteopathic Medicine (PCOM), Philadelphia, USA.
Abstract:
Subacute invasive aspergillosis (SAIA) occurs in immunocompromised patients and/or patients with preexisting pulmonary pathology. An aspergilloma is a fungus ball that occurs in preexisting lung cavities and can be relatively asymptomatic without tissue invasion. In contrast to an aspergilloma, SAIA invades local tissue and parenchyma, resulting in tissue necrosis. We present a case of a 68-year-old immunocompromised female with a past medical history of hypertension, hyperlipidemia, chronic obstructive pulmonary disease (COPD), stage IIIA adenocarcinoma, and a preexisting pulmonary cavity with chronic invasive aspergillosis vs. pulmonary aspergilloma treated with oral (PO) voriconazole. This case demonstrates that invasive aspergillosis should be considered in the differential diagnosis of any pulmonary lung lesion showing tissue invasion and expansion in an immunocompromised patient.
Insights
Subacute invasive aspergillosis (SAIA) is a serious lung infection in immunocompromised patients. Early diagnosis is crucial, as SAIA invades lung tissue, unlike a less harmful aspergilloma.
Area of Science:
- Pulmonology
- Infectious Diseases
- Mycology
Background:
- Subacute invasive aspergillosis (SAIA) affects immunocompromised individuals or those with lung disease.
- Aspergillomas are fungal balls in lung cavities, typically asymptomatic and non-invasive.
- SAIA involves tissue invasion and necrosis, distinguishing it from aspergillomas.
Observation:
- A 68-year-old immunocompromised female presented with a pulmonary lesion.
- The patient had a history of COPD, adenocarcinoma, and a preexisting lung cavity.
- The lesion was suspected to be chronic invasive aspergillosis versus pulmonary aspergilloma.
Findings:
- The case highlights the challenge in differentiating SAIA from aspergilloma based on imaging alone.
- SAIA demonstrates tissue invasion and expansion, a key diagnostic feature.
- Treatment with oral voriconazole was initiated for suspected SAIA.
Implications:
- Invasive aspergillosis must be considered in the differential diagnosis of pulmonary lesions in immunocompromised patients.
- Prompt recognition and treatment of SAIA are essential to prevent disease progression.
- This case underscores the importance of considering invasive fungal infections in complex pulmonary presentations.
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