Subacute invasive pulmonary aspergillosis as a rare cause of pneumothorax in immunocompetent patient: brief report

Abstract

Subacute invasive pulmonary aspergillosis (IPA) represents a form of chronic pulmonary aspergillosis which affects immunocompetent individuals or mildly immunocompromised persons with underlying pulmonary disease. Pneumothorax can be a rare complication of subacute IPA due to a leakage of air from an air-filled lung cavitation into the pleural space. Herein, we report rare and unusual case of pneumothorax in a patient with pulmonary cavity infection. A 40-year-old woman was admitted to thoracic surgery due to complete pneumothorax of the left lung. She was active smoker with untreated chronic obstructive pulmonary disease (COPD). After thoracic drainage multiple cavity forms in the both lungs were noticed. Galactomannan antigen was positive in bronchoalveolar lavage as well as culture of Aspergillus fumigatus. Antifungal treatment by voriconazole was started and continued during 6 months with a favorable outcome. This case highlights that subacute IPA is a diagnose that should be considered in patients with end-stage COPD, low body mass index, or patient who developed pneumothorax. The results of our case show that voriconazole is a safe and effective treatment as primary or salvage therapy in subacute forms of IPA, irrespective of the immunological status of the patients.

Fulminant Tracheobronchial Aspergillosis in an Apparently Healthy Adult

“…The pathogenesis of tracheobronchial aspergillosis in healthy subjects remains unclear (3,9,10). Pathologically, a diagnosis of IPA could not be established based on the results of a TBLB and bronchial biopsy in the present study.…”

“…Tracheobronchial aspergillosis is a well-recognized phenotype of rare invasive pulmonary aspergillosis (IPA); patients suspected of having tracheobronchial aspergillosis require admission to an intensive-care unit and prompt initiation of antifungal therapy (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). We encountered a fatal case of fulminant tracheobronchial aspergillosis in an apparently healthy adult, although most of the previously reported patients with tracheobronchial aspergillosis and IPA were immunocompromised (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”

Complications of chronic necrotizing pulmonary aspergillosis: review of published case reports

“…With regard to the laboratory findings, it has been reported 32 - 35 that tumor markers (carcinoembryonic antigen, squamous cell carcinoma antigen, carbohydrate antigens sialyl Lewis, and sialyl SSEA-1) are often increased in several benign diseases such as pulmonary mycobacterial diseases, and the percentage increase of these tumor marker is 15-62%. Histologically, these tumor markers were expressed in mucous cells of the bronchial gland and the surface of bronchiolar surface epithelium cells 29 , 31 - 33 .…”

“…Although aspergillosis is commonly found in old tuberculous cavities, pulmonary aspergillosis is rarely complicated by active pulmonary TB 34 , 35 . Kohno et al .…”

Disseminated invasive aspergillosis in an immunocompetent patient

“…The patient developed a right tension pneumothorax requiring emergency intubation and chest tube insertion. 1…”