Chronic necrotizing pulmonary aspergillosis mimicking bronchocentric granulomatosis

We present a case of slowly progressive Aspergillus infection occurring in a partially immunocompromised host. The histologic pattern mimicked bronchocentric granulomatosis as seen in allergic bronchopulmonary aspergillosis, but the clinical history, spread of disease in the face of steroid therapy, peculiar granulomatous response to the organisms, and large numbers of organisms present suggest that this was really a case of chronic necrotizing pulmonary aspergillosis. These entities must be distinguished because their therapy, prognosis, and clinical significance are totally different.