A patient with ankylosing spondylitis who presented with chronic necrotising aspergillosis

Abstract

Upper lobe fibrobullous disease is a well-known finding in advanced stages of ankylosing spondylitis (AS). In this report, we present a 57-year-old male patient who was diagnosed with a right apical cavitary lesion after coming to us with the complaint of haemoptysis. The patient underwent upper lobe segmentectomy and an aspergilloma was detected. Histologic findings were in favour of necrotising Aspergillus pneumonia. It was interesting that the patient had not been diagnosed with AS before and presented initially with chronic necrotising Aspergillus pneumonia. In the literature, there are recently published series of pulmonary high-resolution computed tomography (HRCT) in AS which claim that parenchymal abnormalities are quite frequent. Although the clinical significance of these abnormalities is not known with certainty, it has been reported that they might be seen even in early-stage patients. It is suggested that the pulmonary involvement in AS might be affected by mechanical factors related to limitation of motion of the thoracic cage and also by parenchymal inflammation. Here, we review the series of pulmonary HRCT in AS patients.

Pulmonary involvement in ankylosing spondylitis

“…Two case reports [7,8] of aspergillosis developing in fibrocavitary lesion in ankylosing spondylitis have appeared. Franquet et al [7] described a 57-year-old patient with long-standing ankylosing spondylitis who presented with fever, dyspnea and recurrent hemoptysis.…”

“…Saprophytic infection with Aspergillus (aspergilloma) was found. Pamuk et al [8] reported a 57-year-old male with hemoptysis and a right apical cavitary lesion. The patient underwent upper lobe lobectomy and an aspergilloma was found.…”

Chronic Necrotizing Pulmonary Aspergillosis in a Case with Ankylosing Spondylitis

“…Ankilozan spondilit (AS), patogenezi bilinmeyen bir bağdoku hastalığı olup spondilo artropatilerin proprototipidir ve 20-40 yaş arası erkeklerde sık gözlenmektedir [5][6][7]. AS'li hastaların %2'sinden daha azında akciğer tutulumu görülmektedir [8,9].…”

“…Radyolojik olarak akciğer tüberkülozu ve maligniteyi taklit edebilir. Fibro-büllöz tutulumlu olgularda, aspergillus sporları kaviter lezyon içinde kolonize olarak aspergillomaya neden olabilir [6]. Aspergilloma, AS'li hastalarda görülen en sık form olup kronik nekrotizan pulmoner aspergillosis formları nadir olarak görülmektedir [1].…”

Isolation of the Right Upper-Lobe with a Left-Sided Double-Lumen Tube After Left-Pneumonectomy

“…Pul monary upper lobe fibrobullous disease is a complication of advanced ankylosing spondylitis (AS) (1). The medical treatment of AS predisposes patients to pulmonary aspergillosis.…”