Rajalingham Sakthiswary, Anshar Fauzi M
Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000, Cheras, Kuala Lumpur, Malaysia.
J Med Case Rep. 2012 Feb 14;6:62. doi: 10.1186/1752-1947-6-62.
Chronic necrotizing pulmonary aspergillosis is an uncommon subacute form of Aspergillus infection. It typically occurs in immunocompromised individuals and in those with underlying lung disease. This interesting case highlights the occurrence of this entity of aspergillosis in an immunocompetent middle-aged woman with atypical radiological findings. To the best of our knowledge this is the first case report of chronic necrotizing pulmonary aspergillosis presenting with pleural effusion.
Our patient was a 64-year-old Malay woman with a background history of epilepsy but no other comorbidities. She was a lifelong non-smoker. She presented to our facility with a six-month history of productive cough and three episodes of hemoptysis. An initial chest radiograph showed bilateral pleural effusion with bibasal consolidation. Bronchoscopy revealed a white-coated endobronchial tree and bronchoalveolar lavage culture grew Aspergillus niger. A diagnosis of chronic necrotizing pulmonary aspergillosis was made based on the clinical presentation and microbiological results. She responded well to treatment with oral itraconazole.
The radiological findings in chronic necrotizing pulmonary aspergillosis can be very diverse. This case illustrates that this condition can be a rare cause of bilateral pleural effusion.
慢性坏死性肺曲霉病是一种罕见的亚急性曲霉感染形式。它通常发生在免疫功能低下的个体以及患有基础肺部疾病的人群中。这个有趣的病例突出了这种曲霉病实体在一名具有非典型放射学表现的免疫功能正常的中年女性中的发生情况。据我们所知，这是首例以胸腔积液为表现的慢性坏死性肺曲霉病病例报告。
我们的患者是一名64岁的马来女性，有癫痫病史，但无其他合并症。她终生不吸烟。她因有六个月的咳痰病史和三次咯血发作前来我院就诊。最初的胸部X光片显示双侧胸腔积液伴双肺基底段实变。支气管镜检查显示支气管树有白色覆盖物，支气管肺泡灌洗培养出黑曲霉。根据临床表现和微生物学结果诊断为慢性坏死性肺曲霉病。她对口服伊曲康唑治疗反应良好。
慢性坏死性肺曲霉病的放射学表现可能非常多样。该病例表明这种情况可能是双侧胸腔积液的罕见原因。
