Abstract:
Introduction:
Chronic pulmonary aspergillosis can mimic tuberculosis infection, but at the
same time can be an overlapping complication of post-tuberculosis sequelae.
Purpose:
Highlighting the diagnostic difficulties of chronic cavitary pulmonary
aspergillosis in a patient cured of disseminated tuberculosis.
Material and methods:
A 43-year-old patient, ex-smoker (54 p/y), immunocompetent, diagnosed
with disseminated tuberculosis (pulmonary, intestinal, otitis) at the age of
40 (sensitive strain of M. tuberculosis confirmed bacteriologically). Clinical
improvement was observed after 12 months of first-line antituberculous
drug regimen. For the next 2 years he was monitored annually
by chest X-ray and bacteriological examination of the sputum.
Results:
Relapse of tuberculosis infection was suspected in 2 years after completion
of treatment, due to repeated episodes of hemoptysis, cough with purulent
sputum (60 ml/day), weight loss of 6 kg during the lats 3 months, fatigue
and night sweats. M. tuberculosis infection was excluded by negative
molecular and bacteriological tests.
Thoracic HRCT identified cylindrical bronchiectasis and a lung cavity with
fungus ball in each upper lobe of the both lungs. The serum level of IgG for
A.fumigatus within normal limits, no growth of any Aspergillus spp. has
been identified by sputumculture.
Empirical antifungal therapy with itraconazole resulted in improvement of
the symptoms and the absence of hemoptysis episodes.
Conclusions:
The case highlights the diagnostic difficulties of fungal infections in a
patient with post tuberculosis sequelae in a country with an increased
incidence of tuberculosis infection within settings of limited accessibility
tomodern diagnosticmethods for Aspergillus spp.
Description:
Division of Pneumology and Allergology, Department of Internal Medicine,
State University of Medicine and Pharmacy „Nicolae Testemițanu”, Chisinau, Republic of Moldova,
Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltare
