Amit Tanna, Jo Han Yeoh


Please note that this article has been amended from the original article, published in West London Medical Journal, Volume 3, Number 4, 2011, by the author

Pulmonary aspergilloma (mycetoma) is a rare pulmonary infectious disease that manifests clinically with fever, chest pain, chronic cough and haemoptysis, although may be asymptomatic in some patients [1]. 

Here, a case is presented of an elderly gentleman attending hospital coughing up blood-stained sputum.  Thoracic computed tomography (CT) revealed a left apical lung cavity with a mycetoma, presumed secondary to an aspergillus infection.  The fungal ball dropped anteriorly within the cavity when the patient lay on his front, hence confirming the diagnosis.  The haemoptysis settled with Itraconazole; anti-fungals being the treatment-of-choice in symptomatic individuals with a pulmonary aspergilloma.

This gentleman also suffered from severe Churg-Strauss syndrome and required long-term triple immuno-suppressive therapy.  Pulmonary aspergillosis is a serious threat to those immuno-compromised as a result of disease or treatment [2].  This case highlights the importance of considering a mycetoma as a cause for respiratory symptoms in immuno-compromised individuals, especially in those presenting with haemoptysis.

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