A 50-year-old man with a 10-year history of uncontrolled diabetes was admitted to the hospital with hemoptysis. Ten years before the admission, he was treated for pulmonary tuberculosis. A chest radiograph showed heterogeneous consolidation with cavitation in the left upper lobe (Figure 1A, arrow). A chest computed tomography revealed a large cavitary lesion containing radio-opaque material in the left upper lobe (Figure 1B). At bronchoscopy, the left upper lobe bronchus was contiguous with an opening to a cavity (Figure 2A, arrow), which contained necrotic and inflammatory materials and was covered with black mold (Figures 2B–2D). Fungal culture from lavage fluid grew Aspergillus niger, and acid-fast bacilli smears and culture were negative. He was treated with amphotericin B and showed clinical and radiologic improvement.
Figure 1. (A) Chest radiograph and (B) computed tomography showing heterogeneous consolidation with cavitation in the left upper lobe.
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Figure 2. Bronchoscopic views. (A) The opening to a cavity (arrow) in the left upper lobe bronchus; and (B–D) necrotic and inflammatory materials covered with black mold in the cavity.
[More] [Minimize]Chronic pulmonary aspergillosis is a lung disease caused by the fungus Aspergillus in patients with underlying lung disease or mild immunodeficiency (1). Most are attributed to Aspergillus fumigatus, followed by Aspergillus flavus, Aspergillus terreus, and A. niger (2). A. niger releases oxalic acid as a mycotoxin (3), and histologic examination of tissue specimens may reveal the deposition of calcium oxalate crystals (4), although no biopsy has been performed in our case. In chronic pulmonary aspergillosis, Aspergillus species gradually destroys lung tissue, leading to the formation and expansion of a cavity. This is an interesting report about bronchoscopic findings showing the growth of Aspergillus in the lung of a patient with chronic pulmonary aspergillosis.
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| 3. | Roehrl MH, Croft WJ, Liao Q, Wang JY, Kradin RL. Hemorrhagic pulmonary oxalosis secondary to a noninvasive Aspergillus niger fungus ball. Virchows Arch 2007;451:1067–1073. |
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*These authors contributed equally to this report.
Author Contributions: S.J.P., C.R.C., Y.K.R., H.B.L., and Y.C.L. diagnosed this case; S.J.P., C.R.C., and E.Y.K. wrote the manuscript.
Author disclosures are available with the text of this article at www.atsjournals.org.
