Aspergillosis

Case history #1

A 65-year-old man underwent induction chemotherapy for recently diagnosed acute myelogenous leukemia. During chemotherapy-induced neutropenia, he received empiric antibiotic therapy for the fever without an obvious source of infection. Blood cultures were negative and fever subsided. During the third week of neutropenia, fever recurred with dry cough and left-sided pleuritic pain. Physical exam demonstrated no significant abnormalities. Blood cultures remained negative. Chest x-ray was normal. However, a high-resolution computer tomography scan of his chest revealed a 2 cm peripheral nodule with a surrounding "halo" sign in the left upper lobe.

Case history #2

A 67-year-old man with COPD presents with recent changes in his chest x-ray. He has shortness of breath that has unchanged from his baseline status. On examination, he is afebrile with clinical evidence of chronic lung disease. The chest x-ray reveals a right upper lobe cavitary lesion with an intracavitary mass and adjacent pleural thickening.

Other presentations

Invasive sinus disease may present with headache, congestion, or sinus tenderness. Extension of sinus disease into the eye/brain may lead to proptosis, cranial nerve palsies, altered mental status, and seizures. Concomitant involvement of sinus and lungs may occur. Skin involvement is not uncommon, with single or multiple discrete, erythematous, mildly tender nodules of varying sizes. Direct trauma to the skin may result in local invasion, producing a single lesion.

Symptoms of chronic pulmonary aspergillosis include a chronic cough, breathlessness, chest discomfort, weight loss, and malaise.[4]Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax. 2015 Mar;70(3):270-7. https://thorax.bmj.com/content/70/3/270.long http://www.ncbi.nlm.nih.gov/pubmed/25354514?tool=bestpractice.com A simple aspergilloma is usually asymptomatic. Patients with aspergilloma may occasionally present with hemoptysis.