Pulmonary Aspergilloma and Allergic Bronchopulmonary Aspergillosis Following the 2018 Heavy Rain Event in Western Japan

Abstract

A 16-year-old boy with asthma participated in recovery volunteer work following the 2018 heavy rains in Japan. One month later, he experienced chest pain and dyspnea. Chest computed tomography revealed a cavity with a fungal ball, and Aspergillus fumigatus was detected in his bronchoalveolar lavage fluid. He was treated with voriconazole, but new consolidations appeared rapidly. He also experienced allergic bronchopulmonary aspergillosis. After prednisolone prescription, the consolidations improved; however, his asthma worsened. He underwent partial lung resection to avoid allergens, and his symptoms improved. We must recognize cases of infection after a disaster, especially in patients with chronic respiratory diseases.

Keywords: allergic bronchopulmonary aspergillosis; disaster; pulmonary aspergilloma.

Figure 1.

Computed tomography revealed a cavity with a fungal ball (A). Three days later, new consolidations appeared around the cavity (B). After the administration of voriconazole, the consolidations around the cavity improved, although new consolidations appeared (C). After the administration of prednisolone, the consolidations disappeared (D). One month later, the cavity shadows had shrunk further (E). VRCZ: voriconazole, PSL: prednisolone, Eo: eosinophil count, ope: operation

Figure 2.

Chest X-ray (day 5) showed a cavity with consolidation in the right upper lung field.

Figure 3.

Gross specimen of the lung showing a cavity (white arrowhead) (a). Microphotographs of the lung revealed inflammatory cells with fibrosis and lymphoid follicular formation around the cavity (b, c). Many histiocytes with phagocytosed brown pigment containing iron (black arrowhead) were observed (d).