Title : Clinical and radiological features of chronic cavitary pulmonary aspergillosis: A case report
Abstract:
Background: Chronic pulmonary aspergillosis (CPA) is a rare lung disease caused by Aspergillus fungus, o en affec ng those with underlying lung condi ons. Pulmonary tuberculosis (PTB) is the leading cause of CPA worldwide, including an esmated 77,172 cases in the Philippines. Misdiagnosis with tuberculosis or lung cancer is common for chronic cavitary pulmonary aspergillosis (CCPA). Early diagnosis and treatment are crucial to prevent complica ons and improve outcomes.
Case Report: A 53-year-old woman with diabetes and prior PTB was diagnosed with CCPA. She presented with a 4-month cough with blood-nged sputum and was ini ally treated with Voriconazole, which improved her condi on. However, she later presented with recurrent hemoptysis and weight loss. Imaging showed an increased lesion size, and she underwent VATS lobectomy, revealing Aspergillus species. She was treated with Voriconazole for 4 months, resul ng in recovery without recurrence at 6-month follow-up.
Discussion: Aspergillus is a fungus found in various environments that can cause CPA, a rare pulmonary disease with different clinical en es. CCPA is the most common type and is characterized by the presence of mul ple cavi es that may or may not have an aspergilloma, along with pulmonary and systemic symptoms present for at least three months. Diagnosis requires serological or microbiological evidence implica ng Aspergillus spp. and clear radiological progression. Treatment aims to alleviate symptoms and halt disease progression, and a combina on of oral triazole therapy and surgery is o en used. Follow-up imaging is recommended to monitor progress. Prognosis depends on various factors, including age, comorbidi es, and an fungal resistance.
Conclusion: CCPA is a serious lung disease caused by Aspergillus fungus that is o en misdiagnosed, making prompt and accurate diagnosis crucial. Differen a ng CCPA from other lung diseases is important to ensure appropriate treatment. An fungal therapy alone may not be enough, and surgical interven on may be necessary. In resource-poor se ngs, an interprofessional evalua on involving specialists is vital for surgical planning. Further research is needed to improve understanding of CCPA and develop more effec ve treatments for be er outcomes.
