Malnutrition and Mold: When the Body Starves, the Fungus Thrives

Chronic pulmonary aspergillosis (CPA) is typically associated with structural lung disease, such as prior tuberculosis, chronic obstructive pulmonary disease, or immunosuppression. Malnutrition, however, is an under-recognized contributor to immune dysfunction and may predispose to fungal infections. We present two cases of CPA in severely malnourished individuals without significant pre-existing pulmonary pathology. The first case involved a 41-year-old woman with anorexia nervosa, frailty, and osteoporosis who was incidentally found to have right-sided cavitary lesions on trauma imaging following a road accident. Despite positive Aspergillus IgG serology, she remained asymptomatic, and a conservative approach with nutritional rehabilitation was adopted. The second case involved a 41-year-old man with long-standing dietary restriction, who developed a chronic cough and was found to have a right apical cavitary lesion with positive Aspergillus culture. Antifungal therapy was initiated but discontinued due to side effects, and supportive care with physiotherapy and nutritional input was emphasized. These cases highlight malnutrition as a significant and potentially modifiable risk factor in CPA pathogenesis, warranting greater clinical awareness.