Diagnosis of airway-invasive pulmonary aspergillosis by tree-in-bud sign in an immunocompetent patient: case report and literature review

Abstract

Invasive fungal infections are rare in immunocompetent hosts, and diagnosis may be missed or delayed due to our lack of understanding of the particular clinical signs, disease progression, and treatment outcome. Here, we present a case of pulmonary invasive aspergillosis that arose in an immunocompetent and previously healthy patient. The patient presented with a several-week history of remittent high fever, cough, and expectoration. These symptoms were unresponsive to treatments for tuberculosis and pulmonary bacterial infection. Computed tomography images revealed the characteristic bronchiolitis tree-in-bud pattern in the airways. Lung biopsy specimens were culture-positive for Aspergillus fumigatus. Treatment with voriconazole and caspofungin followed by amphotericin B cleared the infection and resolved the symptoms.