Invasive pulmonary aspergillosis - case report and review of literature

Abstract

Invasive pulmonary aspergillosis (IPA) is a severe fungal infection with a high mortality rate. The incidence of IPA is on the rise due to an increase in the number of patients undergoing transplants and receiving chemotherapy and immunosuppressive therapy. Diagnosis is challenging due to the non-specific nature of symptoms. Voriconazole is the mainstay of therapy. We present a case of an elderly woman presenting with acute bronchitis and asthma exacerbation, who succumbed to overwhelming IPA. It is uncommon for IPA to develop in patients on short-term steroid therapy for asthma exacerbation. The possibility of aspergillosis in immunocompetent patients should be considered in those on systemic steroids and deteriorating pulmonary functions.

Keywords: aspergillus; asthma exacerbation; ground glass opacities; steroids; vascular invasion.

Fig. 1

High-resolution computed tomographic scan of the chest revealing multiple foci of ground glass opacities (blue arrows) and bilateral pulmonary nodular infiltrates (green arrows).

Fig. 2

Light microscopic findings of lung specimen (40×) stained with hematoxylin and eosin showing Aspergillus hyphae invading through the bronchial wall. A blood vessel is visible in the lower left field with an occluding thrombus and inflammatory cells in its lumen.

Fig. 3

Hematoxylin and eosin stain of the lung specimen under a light microscope at 200× showing typical branching, septate Aspergillus hyphae, invading through the mucosa of a distal bronchi.