SHM Converge Scientific Abstract ePoster Gallery-Chronic Pulmonary Aspergillosis Dynamics: Lessons From a Subacute Case

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This case report describes a 77-year-old Japanese man with diabetes, hypertension, complete atrioventricular block, and recent corticosteroid therapy for acute lung injury. He was brought to the emergency department with altered consciousness caused by severe hypoglycemia, but further evaluation revealed an inflammatory syndrome with leukocytosis, markedly elevated CRP, and a positive serum Aspergillus galactomannan antigen. Imaging showed a newly developed thick-walled cavitary lesion in the left upper lung, raising suspicion for pulmonary aspergillosis.<br /><br />Although chronic pulmonary aspergillosis (CPA) usually develops gradually over months to years, this patient’s disease evolved within only three months after steroid initiation, suggesting a subacute course in an immunosuppressed host. Bronchoscopy with bronchoalveolar lavage and biopsy confirmed Aspergillus fumigatus, establishing the diagnosis of CPA. After discharge, voriconazole was started. Follow-up CT demonstrated improvement in the cavity and the later appearance of an aspergilloma, showing the dynamic evolution of CPA-related cavitary disease.<br /><br />The report emphasizes several clinical lessons: CPA should be considered early in immunosuppressed patients who develop new cavitary lung lesions, especially those receiving corticosteroids; prompt diagnosis and antifungal treatment may improve outcomes; and multidisciplinary coordination, including the role of the hospitalist, is important for effective care. The case also illustrates that CPA can progress faster than expected and can transition from cavitary disease to aspergilloma over a short period.

Asset Subtitle

Satoshi Fujita

Meta Tag

Author List Satoshi Fujita, Takahito Nei, Yoshitaka Tomoda, Yusuke Yasumoto

Category Clinical Vignettes

Concept Chronic Pulmonary Aspergillosis

Concept Cavitary Lung Lesion

Concept Antifungal Therapy

Concept Immunosuppression

Concept Chest Computed Tomography

Distinguished Non-Finalist

Presenter Organization Itabashi Chuo Medical Center

Presenting Author Satoshi Fujita

Track Adult

Keywords

chronic pulmonary aspergillosis

Aspergillus fumigatus

cavitary lung lesion

corticosteroid therapy

immunosuppressed host

pulmonary aspergillosis

aspergilloma

voriconazole

bronchoalveolar lavage

galactomannan antigen

Chronic Pulmonary Aspergillosis

Cavitary Lung Lesion

Antifungal Therapy

Immunosuppression

Chest Computed Tomography