Pulmonary Aspergilloma in a Young Immunocompetent Female: A Rare Clinical Dilemma

Abstract

Depending on the host's immunological and respiratory systems, Aspergillus can induce infectious and allergic diseases. Most of the spread occurs in immunocompromised people, whereas aggressive disorder in immunocompetent patients is unusual. We report the case of a 19-year-old female who had shortness of breath, right-sided chest discomfort, and intermittent hemoptysis for six months before being diagnosed with pulmonary aspergilloma. The initial chest x-ray revealed a massive right pneumothorax and a 7.2 cm rounded opacity in the right lower lung. A subsequent computed tomography (CT) chest with contrast revealed a 6.7 cm cavitating mass occupying the right lower lobe. An open right thoracotomy and right lower lobectomy showed a cavitary fungus ball with septate branching hyphae and subsequent methenamine silver staining consistent with Aspergillus in conjunction with a positive Aspergillus antigen. We strongly suggest that pulmonary aspergillosis should be suspected regardless of age or immunocompetence in patients with prolonged cough, hemoptysis, unilateral chest discomfort, and pneumothorax.

Metastatic Klebsiella Pneumoniae in an Immunocompetent Patient: A Rare, Atypical Presentation of Klebsiella Syndrome

“…This array of symptoms is often non-specific and seen in other polymicrobial etiologies of hepatic abscesses. Abdominal ultrasound and computer tomography scans are non-specific and show either unilobular or multilobular masses; however, K. pneumoniae liver abscesses often appear more solid with less purulent aspirate than other etiologies [7][8][9][10][11][12]. As patients with liver abscesses have concurrent bacteremia, the definitive diagnosis can be made with positive blood or aspirate culture [1,[13][14][15].…”

“…In a review of 23 cases of PLA with septic metastatic lesions and 164 cases of PLA without septic metastatic lesions, KLA, bacteremia, and diabetes mellitus were significantly more common in the study group than in the comparison group. The most common sites of infectious seeding are endogenous endophthalmitis or uveitis (60%), pulmonary abscesses (43.4%), brain abscess (26%), bacteriuria and prostate abscess (21.7%), osteomyelitis (8.6%), and psoas abscess (4.3%) [ 2 , 9 , 12 , 13 ].…”

Incidental finding of pulmonary tumorlet in a case of surgically treated bronchiectatic cavity superimposed by aspergilloma

“…Spreading of the disease depends of the patients immunological and respiratory systems. Aspergillus causes infectious as well as allergic diseases [2]. Chronic pulmonary aspergillosis (CPA) is often seen in patients with lung diseases that cause structural damage to lung parenchyma, and have the whole spectrum of progressive disease manifestations caused by Aspergillus species [3].…”