Unusual Specific Lesion of Pleura as Result of Delay in Diagnosis of Chronic Pulmonary Aspergillosis: A Case Presentation

摘要

The fungus Aspergillus spp. causes infections in immunocompromised hosts and produces a variety of clinical syndromes including lung tracheobronchial, chronic necrotizing or cavitary pulmonary and allergic bronchopulmonary manifestations, as well as aspergilloma, depending on the type of host-fungus relationship involved. Aspergilloma is usually colonized by Aspergillus spp. lesions in the bronchial tree, while invasive or semi-invasive forms are characterized by the presence of hyphae below its basement membrane. The objective of the present study was to describe the case of a patient with chronic pulmonary aspergillosis in the form of cavitary lesions of lung with infiltrates complicated by pleural empyema, including the clinical course, diagnostic approach and paraclinical care provided. The patient was a 28-year-old female with a history of thymoma who initially presented with febrile and pneumonia 12 years after surgical treatment of tumor. Traditional antibiotic treatment to pneumonia provided no improvement in the patient's condition and computed tomography of the thorax revealed cavities of destruction and pulmonary opacities. Later a bronchopleural fistula (BPF) was formed. A pleura lesion biopsy was performed after Video assisted thorascopic surgery (VATS) revision of pleural cavity showed a white exophytic lesion and pathological changes of pleura. Since pathologic examination revealed numerous septate fungal hyphae exhibiting 45° branching compatible with Aspergillus spp., the patient was treated with voriconazole. We emphasized on the reasons of delay of true diagnosis due to mistakes in management and treatment of clinical syndromes for a long time. In patients with tumor pathology in anamnesis who present with febrile and respiratory symptoms, it is essential to consider fungi as potential etiologic agents including Aspergillus spp., which is common and causes a variety of clinical syndromes.