Multifocal pulmonary aspergillomas: case series and review

Abstract

Multifocal lung parenchymal cavities containing multiple aspergillomas are not well-recognized features of chronic pulmonary aspergillosis (CPA). We identified five patients with multiple cavities containing fungal balls from our accumulated cohort of ∼300 patients with CPA. Corticosteroid exposure and radiological and serological characteristics were assessed. The patients, aged 19-55 years, developed 3-11 cavities (or nodules in one case) with thin walls, usually within the lung parenchyma, with very limited pleural involvement. Four had asthma (severe in three) and one had cystic fibrosis; three had allergic bronchopulmonary aspergillosis. All patients had received corticosteroids orally or by inhalation. Four patients had elevated Aspergillus IgG antibodies; one had elevated Aspergillus-specific IgE. Three patients developed azole resistance on antifungal therapy, after benefit, one of whom underwent a successful bilateral lung transplant, later complicated by a fatal mycotic cerebral aneurysm. Multiple aspergillomas is a new distinct manifestation of CPA. The lack of inflammatory response and the distribution of the cavities in the lungs are remarkable. Aspergillus nodules could evolve into cavities with aspergillomas. The management and development of azole resistance in these patients is problematic.

Results of surgery for chronic pulmonary Aspergillosis, optimal antifungal therapy and proposed high risk factors for recurrence - a National Centre’s experience

“…Among the four patients who died, three of them had recurrence of aspergillosis postoperatively. One patient who had a double lung transplantation for associated cystic fibrosis died of a mycotic brain aneurysm few months following surgery, having developed ARDS after a routine surveillance bronchoscopy and lung biopsy, despite antifungal therapy [15]. The other patient who had single lung transplantation due to associated emphysema and chronic sarcoidosis died 48 months following surgery.…”

Chronic pulmonary aspergillosis

“…Multiple ‘simple aspergillomas’ without thick walls or other typical features of CNPA or CCPA can occur, but are as yet a rare finding …”

“…The fungus ball may be detached from the cavity wall and imitate an air‐crescent sign . Although rare, multiple aspergillomas can occur, therefore bilateral lung involvement on chest CT does not exclude aspergilloma …”

A Rare Co-Existence of Aspergillosis and Pulmonary Hydatid Cyst in Immunocompetant Adults: Two Rare Case Reports and Review of the Literature

“…Therefore, either structural pulmonary or immunological deficiency allows this rapidly growing filamentous fungus to infect localized areas of lung. 3 Pulmonary aspergilloma usually complicates post-tuberculosis cavity. In a study, this ratio was reported as 69% of a series of 89 cases of aspergilloma.…”