Pleural aspergillosis in a patient with recurrent spontaneous pneumothorax: The challenge of an optimal therapeutic approach

Abstract

Pleural aspergillosis (PA) is a rare but potentially fatal disease. Most cases are secondary to bronchopleural fistulae or pleural intervention and can occur in the absence of immunosuppression. We report a case of PA in a young patient after pleurodesis for recurrent pneumothorax. Clinical resolution was achieved with systemic and local antifungal therapy combined with surgical debridement. Hepatotoxicity led to a switch from voriconazole to isavuconazole, with a successful outcome.

Keywords: Hepatotoxicity; Isavuconazole; Pleural aspergillosis; Pleural instillation; Recurrent pneumothorax.

Fig. 1

1A: Thoracic CT scan after the second episode of pneumothorax. Notice the presence of parasseptal emphysema, predominantly in the upper lung, with multiple subpleural blebs. 1B: Thoracic CT scan shows an hydropneumothorax chamber with 10 × 10 cm (axial plane) and 7,5 cm (longitudinal plane) in the right upper lung. 1C: Thoracic CT scan after 6 months of therapy. Evidence of complete resolution of the pneumothorax cavity. Maintenance of pulmonary emphysema.