Aspergillus nodule, a rare variant of chronic pulmonary aspergillosis mimicking as lung cancer

Lung resection surgery for non-small-cell lung cancer (NSCLC) is reportedly a risk factor for developing chronic pulmonary aspergillosis (CPA). However, limited data are available regarding the development of CPA during long-term follow-up after lung cancer surgery. This study aimed to investigate the cumulative incidence and clinical factors associated with CPA development after lung cancer surgery. We retrospectively analyzed 3423 patients with NSCLC who (1) underwent surgical resection and (2) did not have CPA at the time of surgery between January 2010 and December 2013. The diagnosis of CPA was based on clinical symptoms, serological or microbiological evidences, compatible radiological findings, and exclusion of alternative diagnoses. The cumulative incidence of CPA and overall survival (OS) were estimated using the Kaplan–Meier method, and a multivariable Cox proportional hazard analysis was performed to identify factors associated with CPA development. Patients were followed-up for a median of 5.83 years with a 72.3% 5-year OS rate. Fifty-six patients developed CPA at a median of 2.68 years after surgery, with cumulative incidences of 0.4%, 1.1%, 1.6%, and 3.5% at 1, 3, 5, and 10 years, respectively. Lower body mass index (BMI), smoking, underlying interstitial lung disease, thoracotomy, development of postoperative pulmonary complications 30 days after surgery, and treatment with both chemotherapy and radiotherapy were independently associated with CPA development. The cumulative incidence of CPA after surgery was 3.5% at 10 years and showed a steadily increasing trend during long-term follow-up. Therefore, increased awareness regarding CPA development is needed especially in patients with risk factors.

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Aspergillus Sternomyelitis Developed from Chronic Pulmonary Aspergillosis as a Late Complication to Lobectomy for Lung Cancer

Internal Medicine ◽

10.2169/internalmedicine.0334-17 ◽

2018 ◽

Vol 57 (20) ◽

pp. 2991-2994

Author(s):

Yuji Uehara ◽

Hajime Kasai ◽

Takahiro Nakajima ◽

Nobuhiro Tanabe ◽

Koichiro Tatsumi ◽

...

Keyword(s):

Lung Cancer ◽

Late Complication ◽

Pulmonary Aspergillosis ◽

Chronic Pulmonary Aspergillosis

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Case Report: Chronic Pulmonary Aspergillosis—An Unusual Long-Term Complication of Lung Cancer Treatment

Frontiers in Medicine ◽

10.3389/fmed.2021.777457 ◽

2022 ◽

Vol 8 ◽

Author(s):

Katarzyna Guziejko ◽

Katarzyna Klukowska ◽

Urszula Budzińska ◽

Robert Marek Mróz

Keyword(s):

Lung Cancer ◽

Fungal Infection ◽

Antifungal Therapy ◽

Rare Complication ◽

Locally Advanced ◽

Delayed Diagnosis ◽

Pulmonary Aspergillosis ◽

Radical Treatment ◽

Significant Clinical Improvement ◽

Chronic Pulmonary Aspergillosis

Background: Chronic pulmonary aspergillosis (CPA) is a rare complication of radiochemotherapy for lung cancer. It may develop months or years after radical treatment. The diagnosis of CPA is challenging and complex. Not only fungal infection but also cancer relapse always have to be taken under consideration. Antifungal therapy is the base treatment, especially in the case when a surgical procedure is not possible. Standard treatment for at least 6 months is recommended but the optimal duration of the antifungal therapy is unknown. We present the clinical case of CPA, in which we had to perform multidirectional diagnostic tests to confirm the diagnosis and modified treatment due to the recurrence of the disease.Case Presentation: We report a patient who developed CPA three and a half years after concurrent radiochemotherapy for locally advanced non-small-cell lung cancer. Non-specific symptoms were the cause of delayed diagnosis of fungal infection. Samples collected during bronchoscopy allowed to exclude the recurrence of lung cancer and establish the diagnosis of CPA. The patient was treated with itraconazole for 6 months. A few months later, controlled chest CT scans revealed the progression of CPA. Initially, retreatment with itraconazole was implemented. Due to the progression of fungal infection, voriconazole was used in the second line of treatment. Unfortunately, this therapy was complicated by the side effects and deterioration of the patient's condition. The reintroduction of itraconazole resulted in clinical and radiological improvement. Treatment is scheduled for at least 12 months.Conclusion: Chronic pulmonary aspergillosis (CPA) was the cause of clinical deterioration and radiological progression in a patient after the radical treatment of lung cancer. In the described case, the diagnosis of CPA was delayed because of the suspicion of the recurrence of lung cancer. As the surgery was not possible, antifungal therapy with itraconazole was implemented and the proper dosage and duration led to significant clinical improvement.

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Chronic pulmonary aspergillosis as a sequel to lobectomy for lung cancer

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivv239 ◽

2015 ◽

Vol 21 (5) ◽

pp. 650-656 ◽

Cited By ~ 4

Author(s):

Atsuhisa Tamura ◽

Junko Suzuki ◽

Takeshi Fukami ◽

Hirotoshi Matsui ◽

Shinobu Akagawa ◽

...

Keyword(s):

Lung Cancer ◽

Pulmonary Aspergillosis ◽

Chronic Pulmonary Aspergillosis

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Faculty Opinions recommendation of Efficacy and safety of posaconazole for chronic pulmonary aspergillosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.6381956.6480055 ◽

2010 ◽

Author(s):

John Baddley

Keyword(s):

Efficacy And Safety ◽

Pulmonary Aspergillosis ◽

Chronic Pulmonary Aspergillosis

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Misdiagnosis of chronic pulmonary aspergillosis as pulmonary tuberculosis at a tertiary care center in Uganda: a case series

Journal of Medical Case Reports ◽

10.1186/s13256-021-02721-9 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Richard Kwizera ◽

Andrew Katende ◽

Felix Bongomin ◽

Lydia Nakiyingi ◽

Bruce J. Kirenga

Keyword(s):

Pulmonary Tuberculosis ◽

Treatment Outcomes ◽

Diagnostic Criteria ◽

Tertiary Care ◽

Chest Imaging ◽

Resource Limited Settings ◽

Pulmonary Aspergillosis ◽

Resource Limited ◽

Chronic Pulmonary Aspergillosis ◽

Hiv Negative

Abstract Background Diagnosis of chronic pulmonary aspergillosis (CPA) is based on a combination of clinical symptomatology, compatible chest imaging findings, evidence of Aspergillus infection and exclusion of alternative diagnosis, all occurring for more than 3 months. Recently, a rapid, highly sensitive and specific point-of-care lateral flow device (LFD) has been introduced for the detection of Aspergillus-specific immunoglobulin (Ig)G, especially in resource-limited settings where CPA is underdiagnosed and often misdiagnosed as smear-negative pulmonary tuberculosis (PTB). Therefore, in our setting, where tuberculosis (TB) is endemic, exclusion of PTB is an important first step to the diagnosis of CPA. We used the recently published CPA diagnostic criteria for resource-limited settings to identify patients with CPA in our center. Case presentation Three Ugandan women (45/human immunodeficiency virus (HIV) negative, 53/HIV infected and 18/HIV negative), with a longstanding history of cough, chest pain, weight loss and constitutional symptoms, were clinically and radiologically diagnosed with PTB and empirically treated with an anti-tuberculous regimen despite negative microbiological tests. Repeat sputum Mycobacteria GeneXpert assays were negative for all three patients. On further evaluation, all three patients met the CPA diagnostic criteria with demonstrable thick-walled cavities and fungal balls (aspergilomas) on chest imaging and positive Aspergillus-specific IgG/IgM antibody tests. After CPA diagnosis, anti-TB drugs were safely discontinued for all patients, and they were initiated on capsules of itraconazole 200 mg twice daily with good treatment outcomes. Conclusions The availability of simple clinical diagnostic criteria for CPA and a LFD have the potential to reduce misdiagnosis of CPA and in turn improve treatment outcomes in resource-limited settings.

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Performance of LDBio Aspergillus WB and ICT Antibody Detection in Chronic Pulmonary Aspergillosis

Journal of Fungi ◽

10.3390/jof7040311 ◽

2021 ◽

Vol 7 (4) ◽

pp. 311

Author(s):

Anna Rozaliyani ◽

Findra Setianingrum ◽

Sresta Azahra ◽

Asriyani Abdullah ◽

Ayu Eka Fatril ◽

...

Keyword(s):

Receiver Operating Curve ◽

Antibody Detection ◽

Pulmonary Aspergillosis ◽

Comparative Performance ◽

Tuberculosis Patients ◽

Chronic Pulmonary Aspergillosis ◽

Screening Assays ◽

Roc Area ◽

Flow Detection ◽

Sensitivity Specificity

The detection of Aspergillus antibody has a key role in the diagnosis of chronic pulmonary aspergillosis. Western blot (WB) and immunochromatography (ICT) lateral flow detection of Aspergillus antibody can be used as confirmatory and screening assays but their comparative performance in TB patients is not known. This study investigated the performance of these assays among 88 post-tuberculosis patients with suspected CPA. Sensitivity, specificity, receiver operating curve (ROC), area under-curve (AUC) and the agreement between two assays were evaluated. Both WB and ICT showed good sensitivity (80% and 85%, respectively) for detection of Aspergillus antibodies. Substantial agreement (0.716) between these assays was also obtained. The highest AUC result (0.804) was achieved with the combination of WB and ICT. The global intensity of WB correlated with the severity of symptoms in CPA group (p = 0.001). The combination of WB and ICT may increase specificity in CPA diagnosis.

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