A silent invader: Invasive pulmonary aspergillosis in an immunocompetent host

Invasive pulmonary aspergillosis (IPA) is a fulminant fungal infection that predominantly occurs in immunocompromised patients; however, it may occasionally be encountered in immunocompetent individuals, often leading to diagnostic delay and unfavorable outcomes. We describe a case of invasive pulmonary aspergillosis (IPA) in an immunocompetent woman in her mid-20s who presented with productive cough, hemoptysis, low-grade fever, and pleuritic chest pain, closely resembling pulmonary tuberculosis at initial evaluation. While the chest x-ray was normal, high-resolution computed tomography of the chest demonstrated a characteristic halo sign in the right middle lobe. Further evaluation with bronchoscopy and bronchoalveolar lavage revealed a markedly elevated galactomannan index, and fungal culture grew Aspergillus flavus. Hence the patient was initiated on oral voriconazole in accordance with Infectious Diseases Society of America guidelines, resulting in complete clinico-radiological resolution. In immunocompetent patients with persistent respiratory symptoms and suggestive imaging results, this report emphasizes the significance of maintaining a high index of suspicion for IPA. It also emphasizes the importance of early intervention in the form of bronchoscopic evaluation and prompt antifungal therapy in achieving favorable outcomes.