A CASE OF CHRONIC PULMONARY ASPERGILLOSIS AS THE INITIAL PRESENTATION FOR SARCOIDOSIS

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Subacute invasive pulmonary aspergillosis is a locally subacute form of chronic (CPA) which typically involves the upper lobes individuals with pre-existing lung disease or immunodeficiency. Patients fibrocystic sarcoidosis are prone to CPA. We described case complicated CPA was diagnosed concomitantly. CASE PRESENTATION: A 34 year old male no past medical history presented hemoptysis for 3 days, associated productive cough, exertional dyspnea and skin rashes over his arms face year. Physical examination revealed multiple violaceous plaque bilateral face; reduced breath sounds zones. CT cavitations, left lobe mass-like consolidation, approximately 2.9 cm air crescent sign. Laboratory tests were notable lymphopenia, ESR 43 mm/h, CD4+ count 244, Aspergillus Ag 0.6, IgG positive, serum ACE 178 U/L, fungal culture from bronchial alveolar lavage (BAL) isolated species. ANCA, Histoplasma Ag, Cryptococcal HIV Ag-Ab, Quantiferon TB, Sputum acid fast smear negative. Endobronchial ultrasound fine needle aspiration (FNA) subcarinal lymph nodes showed non-caseating granuloma. Skin biopsies extremities lesions granulomas without microorganisms seen. The patient started on Voriconazole months duration scheduled outpatient follow up. DISCUSSION: predisposed due underlying involvement especially in addition mildly immunocompromised state, as evidenced by low CD4 count. diagnosis made based symptomatology (chronic hemoptysis), cavitations Chest, positive BAL It challenge making concomitant Sarcoidosis it exclusion. Diagnosis cannot be resulted FNA can present similar picture. rash appeared ultimately leads us after confirmation granuloma biopsy. CONCLUSIONS: background risk factors disease. essential have high clinical suspicion undiagnosed processes when any obvious factors. serious complication mortality morbidity. Unfortunately, there consensus currently how best treat patients REFERENCE #1: Denning DW, Cadranel J, Beigelman-Aubry C, et al. Chronic aspergillosis: rationale guidelines management. Eur Respir J. 2016;47(1):45-68. doi:10.1183/13993003.00583-2015 #2: Alastruey-Izquierdo A, Flick H, Treatment Pulmonary Aspergillosis: Current Standards Future Perspectives. Respiration. 2018;96(2):159-170. doi:10.1159/000489474 #3: Pleuvry Cole DC. Global burden complicating sarcoidosis. 2013;41(3):621-626. doi:10.1183/09031936.00226911 DISCLOSURES: No relevant relationships Farahnaz Anwar, source=Web Response James Choi, Si Yuan Khor, Jason Liu Liu, Akhil Sharma, Enhua Wang,