INVASIVE PULMONARY ASPERGILLOSIS IN THE IMMUNOCOMPETENT HOST
2023; Elsevier BV; Volume: 164; Issue: 4 Linguagem: Inglês
10.1016/j.chest.2023.07.787
ISSN1931-3543
AutoresA. Krebs, K. Bird, FAHID ALGHANIM,
Tópico(s)Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
ResumoSESSION TITLE: Chest Infections Case Report Posters 20 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Invasive pulmonary aspergillosis (IPA) is usually an infection of the immunocompromised host or those with underlying lung disease. Rarely, the immunocompetent host can have IPA that presents as an upper lobe mass mimicking malignancy. CASE PRESENTATION: A 54-year-old female with significant past medical history of 40-pack per year tobacco dependence in remission who presented to outpatient pulmonology clinic for right upper lung mass with mediastinal adenopathy found on CT chest (Figure 1). She was experiencing shortness of breath, congestion, and wheezing for the past couple months. She denied any recent travel, history of TB infection, autoimmune disorders or personal or family history of lung cancer. Chest X-ray revealed right upper lobe nodularity, and chest CT was recommended. Initial CT chest showed extensive infiltrating low density tumor of the right upper lobe of the lung with additional paratracheal lymphadenopathy (Figure 1). Patient subsequently underwent endobronchial ultrasound with transbronchial needle aspiration (EBUS TBNA) that ruled out malignancy; bronchoscopic cultures were positive for Aspergillus fumigatus. She started on voriconazole and reported improvement in her symptoms. Repeat chest CT two months later showed near resolution of the prior dense consolidation with regions of residual parenchymal scarring and prominent post-infectious bronchiectasis (Figure 2). DISCUSSION: Aspergillosis can have various manifestations depending on the host. Typically, the immunocompetent host will present with a well-defined aspergilloma, or fungal ball, in the lung while the immunosuppressed host will have invasive pulmonary aspergillosis. Aspergillosis invades the immunosuppressed host by entering the lung through the bronchi and producing local bronchitis. The fungus then infiltrates the bronchial wall into the pulmonary artery and produces thrombosis and infarction of the lung which will be seen as a diffuse peripheral infiltrate on radiography, concerning for cancer. This presentation is so rare in the immunocompetent host that there have only been a few cases reported in the literature. CONCLUSIONS: Aspergillosis in rare cases can manifest as invasive pulmonary aspergillosis in the immunocompetent host without underlying cavitary lesions. This presentation is unusual and can be mistaken for malignancy on radiography alone. Thus, it is important to consider aspergillosis as a differential in immunocompetent hosts as to not delay proper treatment. REFERENCE #1: Yoon SH, Park CM, Goo JM, Lee HJ. Pulmonary aspergillosis in immunocompetent patients without air-meniscus sign and underlying lung disease: CT findings and histopathologic features. Acta Radiol. 2011 Sep 1;52(7):756-61. doi: 10.1258/ar.2011.100481. Epub 2011 May 19. PMID: 21596796. REFERENCE #2: Latgé JP, Chamilos G. Aspergillus fumigatus and Aspergillosis in 2019. Clin Microbiol Rev. 2019 Nov 13;33(1):e00140-18. doi: 10.1128/CMR.00140-18. PMID: 31722890; PMCID: PMC6860006. REFERENCE #3: Kang, E.-Y., Kim , D. H., & Woo , O. H. (2001, December 10). Pulmonary aspergillosis in immunocompetent hosts without underlying ... AJR Online . Retrieved March 23, 2023, from https://www.ajronline.org/doi/pdfplus/10.2214/ajr.178.6.1781395 DISCLOSURES: No relevant relationships by Fahid Alghanim No disclosure on file for Kimberly Bird No relevant relationships by Alexa Krebs
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