Pulmonary aspergillosis causing recurrent hydropneumothorax in an immunocompetent patient

A Caucasian male in their 30s was referred by their general practitioner to hospital with 3 days of acute shortness of breath and a chest X-ray showing right-sided pneumothorax. CT chest demonstrated lobulated cavitating lesions with air-fluid levels in the right upper lobe, with aspergillus PCR being positive on pleural fluid and needle biopsy of the cavity's rim. The patient was refractory to medical therapy with antifungal agents; management challenges included drug interactions from concurrent anti-epileptics. Considering this, they underwent a right upper lobe wedge resection, decortication and pleurodesis. Following surgery, antifungal therapy continued for 6 months. Chronic pulmonary aspergillosis can manifest with varied clinical presentations depending on immune status and underlying lung disease. These include the rapidly progressing subacute invasive aspergillosis and the slowly progressing chronic cavitary pulmonary aspergillosis (CCPA). This report details an unusual case of an immunocompetent patient presenting with recurrent hydropneumothorax secondary to CCPA.