PULMONARY PUZZLE
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Considering the remarkable response to chemotherapy, the new lung nodule did not seem to be a metastatic lesion of the primary lung cancer. Percutaneous needle aspiration showed abundant aspergillus fungal hyphae on specimens. Taking the clinical course into account, a final diagnosis of chronic necrotising pulmonary aspergillosis was made (fig 1A). After treatment with voriconazole for 6 months, only the fibrotic scar remained and the medication was discontinued (fig 1B). Complete response of the lung cancer was obtained with further chemoradiotherapy and has been sustained for almost 2 years to date.
Figure 1 (A) Histological examination of aspirated specimens showing aspergillus fungal hyphae (Papanicolaou stain, x400). (B) CT scan obtained 6 months after antifungal treatment showing complete resolution of the nodule with residual parenchymal scar formation.
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Aspergillus is a ubiquitous saprophytic fungus which causes a variety of human illnesses ranging from
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Thorax 2009 64: 682.[Extract] [Full Text] [PDF]
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