Pulmonary aspergillosis: A case report of a late diagnosis

Abstract

Introduction: Pulmonary aspergillosis presents several clinical manifestations depending on the intensity of the immune response. They are frequent and the diagnosis is easy in view of the clinical context and the mycological examination. We report here a case of delayed diagnosis in our context of difficult accessibility of some examinations. Presentation of the case: Mr S. B., 38 years old, farmer, with no particular pathological history, presented for 4 years repeated episodes of hemoptysis and bladder fever. He had a good general condition, apyrexia and polypnea. The Xpert MTB/RIF test and the bacteriological examination of the sputum were negative. The blood count showed hyper-neutrophilia, hypo-eosinophilia and anemia. The C-reactive protein was very high (109 mg/l). Bronchial fibroscopy with BAL for the detection of Mycobacterium was negative. Chest radiographs showed discrete bilateral alveolar-interstitial opacities. Therapeutically, broad-spectrum antibiotic therapy and symptomatic treatment were instituted without success. Then, a thoracic CT scan showed a cavitated image in front of which, a mycological examination of the washed sputum was requested and identified Aspergillus fumigatus, and confirmed by the aspergillary serology. The diagnosis of chronic invasive pulmonary aspergillosis was retained. The evolution was favorable clinically and radiologically under treatment with Itraconazole. Conclusion: The diagnosis of Aspergillosis can be slow in the absence of obvious signs, hence the need to also perform examinations such as a thoracic CT scan and mycological examination, despite our context of poverty.