SECONDARY SPONTANEOUS PNEUMOTHORAX FROM INVASIVE ASPERGILLUS

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cavitary lung disease carries long term morbidity and mortality especially in patients with severe obstructive disease. Recognizing invasive aspergillosis as a rare but possible etiology for spontaneous pneumothorax is important prompt diagnosis management. CASE PRESENTATION: A 59 year-old female COPD presented acute on chronic hypoxic respiratory failure. Initial work-up revealed right upper lobe (RUL) infiltrates. She was treated levofloxacin community acquired pneumonia shortly discharged home. week later, she returned similar symptoms. Her chest X-ray showed an interval increase of the RUL opacities; CT confirmed cavitary lesion. investigations included sputum samples serum fungal panel which were negative. gram stain cultures repeatedly positive Alcaligenes species. empirically piperacillin-tazobactam failed to improve, later broadened meropenem. Bronchoscopy BAL subsequent culture also Fungal staining, antigen testing AFB had mild improvement her Few days decompensation resulting cardiopulmonary arrest. moderately sized diagnosed tube placed. required intubation mechanical ventilation. from noted have mold growth specified Aspergillus species; caspofungin therapy started. Unfortunately clinical condition worsened passed DISCUSSION: infection well-known advanced immunodeficiencies. In immunocompetent hosts, like our patient, this fairly uncommon. Spontaneous has been documented However, association progressive Aspergillosis rare, described high mortality. No strong consensus review recognized treatment such condition. It case reports that early long-term antifungal emergent resection selective population may improve prognosis High vigilance recognizing process crucial CONCLUSIONS: Secondary aspergillus entity cases. should be considered cases appropriate REFERENCE #1: Segal BH. Aspergillosis. N Engl J Med. 2009 Apr 30;360(18):1870-84. doi: 10.1056/NEJMra0808853. PMID: 19403905. #2: Zhang, W., Hu, Y., Chen, L. et al. Pleural complicated by recurrent pneumothorax: report. Med 4, 180 (2010). https://doi.org/10.1186/1752-1947-4-180 #3: Pietro Martino, Corrado Girmenia, Mario Venditti, Alessandra Micozzi, Giuseppe Gentile, Ruggero Raccah, Elvira Martinelli, Erino Rendina, Franco Mandelli, Pneumothorax Complicating Pulmonary Mycetoma Patients Acute Leukemia, Reviews Infectious Diseases, Volume 12, Issue July-August 1990, Pages 611–617, https://doi.org/10.1093/clinids/12.4.611 DISCLOSURES: relevant relationships Chien-Ting Kao, source=Web Response Young Ju Lee, Ahmad Salem,