Pulmonary aspergilloma presenting with recurrent hemoptysis in a patient with previously treated pulmonary tuberculosis: a case report from a rural hospital in Ketapang Regency
Main Article Content
Keywords
Pulmonary aspergilloma, aspergillosis, hemoptysis, tuberculosis, surgery, resection
Abstract
Introduction: Pulmonary aspergilloma, also known as mycetoma or fungus ball, is a type of pulmonary aspergillosis characterized by colonizing fungi within a preexisting lung cavity, typically in previously healed tuberculosis (TB). We present a case report from a rural hospital in Ketapang Regency, Indonesia, highlighting the complexities of diagnosing and managing pulmonary aspergilloma in a patient with a history of treated pulmonary TB.
Case Description: A 32-year-old man with recurrent hemoptysis, fever, weight loss, and productive cough sought care after years of inconclusive tests. Despite a history of pulmonary TB and multiple negative acid-fast bacilli tests, a thorax computed tomography scan showed the presence of aspergilloma within the upper lobe of the left lung. He was given antifungal therapy. During follow-up, he continued to experience recurrent hemoptysis. Eventually, he was referred to a provincial referral hospital with cardiothoracic surgical facilities for definitive surgical management.
Conclusion: Pulmonary aspergilloma presents significant challenges in diagnosis and management. Recurrent or massive hemoptysis, a hallmark symptom of this condition, demands vigilant attention in patients with a history of pulmonary TB.
References
2. Mohamed A, Obanda BA, Njeri HK, Loroyokie SN, Mashedi OM, Ouko TT, et al. Serological evidence of chronic pulmonary aspergillosis in tuberculosis patients in Kenya. BMC Infect Dis. 2022;22(1):1-8.
3. Rozaliyani A, Rosianawati H, Handayani D, Agustin H, Zaini J, Syam R, et al. Chronic pulmonary aspergillosis in post tuberculosis patients in indonesia and the role of ldbio aspergillus ict as part of the diagnosis scheme. J Fungi. 2020;6(4):1-10.
4. Setianingrum F, Rozaliyani A, Syam R, Adawiyah R, Tugiran M, Sari CYI, et al. Evaluation and comparison of automated and manual ELISA for diagnosis of chronic pulmonary aspergillosis (CPA) in Indonesia. Diagn Microbiol Infect Dis. 2020;98(3):115124.
5. Gaffney S, Kelly DM, Rameli PM, Kelleher E, Martin-Loeches I. Invasive pulmonary aspergillosis in the intensive care unit: current challenges and best practices. APMIS. 2023;1-14.
6. Akram W, Ejaz MB, Mallhi TH, Bin Syed Sulaiman SA, Khan AH. Clinical manifestations, associated risk factors and treatment outcomes of chronic pulmonary aspergillosis (CPA): experiences from a tertiary care hospital in Lahore, Pakistan. PLoS One. 2021;16:1-17.
7. Kousha M, Tadi R, Soubani AO. Pulmonary aspergillosis: a clinical review. Eur Respir Rev. 2011;20(121):156-74.
8. Rajpurohit R, Wagh P, Heda M, Dubey G, Gujar PS. Prevalence of chronic pulmonary aspergillosis in fibrocavitary pulmonary tuberculosis patients. J Fam Med Prim Care. 2023;12(1):106-10.
9. Iqbal N, Irfan M, Mushtaq A, Jabeen K. Underlying conditions and clinical spectrum of chronic pulmonary aspergillosis (CPA): an experience from a tertiary care hospital in Karachi, Pakistan. J Fungi. 2020;6(2):2-8.
10. Alsalman J, Zaid T, Makhlooq M, Madan M, Mohamed Z, Alarayedh A, et al. A retrospective study of the epidemiology and clinical manifestation of invasive aspergillosis in a major tertiary care hospital in Bahrain. J Infect Public Health. 2017;10(1):49-58.
11. Iqbal N, Irfan M, Zubairi ABS, Jabeen K, Awan S, Khan JA. Clinical manifestations and outcomes of pulmonary aspergillosis: experience from Pakistan. BMJ Open Respir Res. 2016;3(1).
12. Amchentsev A, Kurugundla N, Saleh AG. Aspergillus-related lung disease. Respir Med CME. 2008;1(3):205-15.
13. El Hammoumi MM, Slaoui O, El Oueriachi F, Kabiri EH. Lung resection in pulmonary aspergilloma: experience of a Moroccan center vascular and thoracic surgery. BMC Surg. 2015;15(1):1-6.
14. Ekeng BE, Davies AA, Osaigbovo II, Warris A, Oladele RO, Denning DW. Pulmonary and extrapulmonary manifestations of fungal infections misdiagnosed as tuberculosis: the need for prompt diagnosis and management. J Fungi. 2022;8(5):1-16.
15. Yaman M, Sugiri J, Putra N, Santosaningsih D, Aslam A. Successful embolization in recurrent hemoptysis caused by pulmonary aspergilloma: a Case Report. Malang Respir J. 2023;5(1):295-303.
16. Nugroho GMS, Wulandari L. Hemoptysis in a patient with pulmonary aspergilloma and type 2 diabetes mellitus: a rare case in an Indonesian adult. Int J Surg Case Rep. 2021;84(6):106125.
17. Kokkonouzis I, Athanasopoulos I, Doulgerakis N, Tsonis G, Lampaditis I, Saridis N, et al. Fatal hemoptysis due to chronic cavitary pulmonary aspergillosis complicated by nontuberculous mycobacterial tuberculosis. Case Rep Infect Dis. 2011;2011:1-4.
18. Ando T, Kawashima M, Masuda K, Takeda K, Okuda K, Suzuki J, et al. Exacerbation of chronic pulmonary aspergillosis was associated with a high rebleeding rate after bronchial artery embolization. Respir Investig. 2019;57(3):260-7.
19. Shin B, Koh WJ, Shin SW, Jeong BH, Park HY, Suh GY, et al. Outcomes of bronchial artery embolization for life-threatening hemoptysis in patients with chronic pulmonary aspergillosis. PLoS One. 2016;11(12):1-10.
20. Kaufman CS, Kwan SW. Bronchial artery embolization. Semin Intervent Radiol. 2022;39(3):210-7.
21. Sopko DR, Smith TP. Bronchial artery embolization for hemoptysis. Semin Interv Radiol. 2011;28(1):48-62.
22. Ofori A, Steinmetz A, Akaasi J, Frimpong G, Norman B, Obeng-Baah J, et al. Pulmonary aspergilloma: an evasive disease. Int J Mycobacteriology. 2016;5(2):235-9.
23. Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax. 2015;70(3):270-7.
24. Chen X, Zhou Y, Zhang L, Xu J, Liang S. The effects of antifungal therapy on the recurrence of aspergillus infection after pulmonary aspergilloma resection: a study protocol for a single-center, prospective, non-blind, randomized, 24-month, parallel group study. BMC Pulm Med. 2021;21(1):1-7.
25. Hicham H, Rabiou S, Ibrahim I, Marouane L, Yassine O, Mohamed S. Pulmonary aspergilloma: from classification to management. Asian Cardiovasc Thorac Ann. 2020;28(1):33-8.
26. Lang M, Lang AL, Chauhan N, Gill A. Non-surgical treatment options for pulmonary aspergilloma. Respir Med. 2020;164:105903.
27. Patterson TF, Thompson GR, Denning DW, Fishman JA, Hadley S, Herbrecht R, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63(4):e1-60.
28. Cadranel J, Philippe B, Hennequin C, Bergeron A, Bergot E, Bourdin A, et al. Voriconazole for chronic pulmonary aspergillosis: a prospective multicenter trial. Eur J Clin Microbiol Infect Dis. 2012;31(11):3231-9.
29. Gupta PR, Jain S, Kewlani JP. A comparative study of itraconazole in various dose schedules in the treatment of pulmonary aspergilloma in treated patients of pulmonary tuberculosis. Lung India. 2015;32(4):342-6.
30. Yang L, Yang C, Wan N, Xie W, Tian Y, Xiao Y, et al. Bronchoscopic instillation of amphotericin B is a safe and effective measure to treat pulmonary mycosis. Front Pharmacol. 2023;14:1-10.
31. Denning DW, Cadranel J, Beigelman-Aubry C, Ader F, Chakrabarti A, Blot S, et al. Chronic pulmonary aspergillosis: Rationale and clinical guidelines for diagnosis and management. Eur Respir J. 2016;47(1):45-68.
32. Nonga BN, Bang GA, Jemea B, Savom E, Yone P, Mbatchou N, et al. Complex pulmonary aspergilloma: surgical challenges in a third world setting. Surg Res Pract. 2018;2018:1-7.
33. Sameer M, David N, Rao VM, Benjamin SR, Gnanamuthu BR, Mohammad A, et al. Surgical management of pulmonary aspergilloma-12 years’ experience from a tertiary care centre in India. Indian J Thorac Cardiovasc Surg. 2021;37(4):402-10.
34. Muniappan A, Tapias LF, Butala P, Wain JC, Wright CD, Donahue DM, et al. Surgical therapy of pulmonary aspergillomas: a 30-year North American experience. Ann Thorac Surg. 2014;97(2):432-8.
35. Moodley L, Pillay J, Dheda K. Aspergilloma and the surgeon. J Thorac Dis. 2014;6(3):202-9.
36. Kumar A, Asaf B Bin, Puri HV, Lingaraju VC, Siddiqui S, Venkatesh PM, et al. Video-assisted thoracoscopic surgery for pulmonary aspergilloma. Lung India. 2017;34(4):318-23.
37. Khan MA, Dar AM, Kawoosa NU, Ahangar AG, Lone GN, Bashir G, et al. Clinical profile and surgical outcome for pulmonary aspergilloma: nine year retrospective observational study in a tertiary care hospital. Int J Surg. 2011;9(3):267-71.
38. Pihlajamaa K, Anttila VJ, Räsänen J V., Kauppi JT, Hodgson U. The fate of aspergilloma patients after surgical treatment-experience from 22 cases. J Thorac Dis. 2019;11(10):4298-307.
39. Garner M, Brunswicker A. Surgical management of pulmonary aspergilloma. Shanghai Chest. 2023;7:1-5.
40. Bongomin F. Post-tuberculosis chronic pulmonary aspergillosis: an emerging public health concern. PLoS Pathog. 2020;16(8):1-6.
41. Lamoth F, Calandra T. Pulmonary aspergillosis: diagnosis and treatment. Eur Respir Rev. 2022;31(166):1-15.
42. Kasprzyk M, Pieczyński K, Mania K, Gabryel P, Piwkowski C, Dyszkiewicz W. Surgical treatment for pulmonary aspergilloma-early and long-term results. Kardiochirurgia i Torakochirurgia Pol. 2017;14(2):99-103.
43. Patel DC, Bhandari P, Epstein DJ, Liou DZ, Backhus LM, Berry MF, et al. Surgical resection for patients with pulmonary aspergillosis in the national inpatient sample. J Thorac Dis. 2021;13(8):4977-87.
44. Ro’isah R, Anies, Sakundano M, Jazuli N. TB community empowerment model instruments in finding tuberculosis (TB) suspects. Bali Med J. 2022;11(2):551-4.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Herick Alvenus Willim, General Practitioner, Dr. Agoesdjam Regional Public Hospital, Ketapang Regency, West Kalimantan, Indonesia
General Practitioner, Dr. Agoesdjam Regional Public Hospital, Ketapang Regency, West Kalimantan, Indonesia
Eva Lydia Munthe, Department of Pulmonology and Respiratory Medicine, Dr. Agoesdjam Regional Public Hospital, Ketapang Regency, West Kalimantan, Indonesia
Department of Pulmonology and Respiratory Medicine, Dr. Agoesdjam Regional Public Hospital, Ketapang Regency, West Kalimantan, Indonesia
Widi Mujono, Department of Radiology, Dr. Agoesdjam Regional Public Hospital, Ketapang Regency, West Kalimantan, Indonesia
Department of Radiology, Dr. Agoesdjam Regional Public Hospital, Ketapang Regency, West Kalimantan, Indonesia