Rare clinical presentation of invasive pulmonary aspergillosis in patient with early-stage lung cancer: a case report

Abstract

Invasive pulmonary aspergillosis (IPA) presents life-threatening complication mostly seen in patients with severe neutropenia or in patients with solid organ cancers after applied anticancer therapy. The aim of this manuscript is to identify clinical manifestations of IPA in lung cancer patient. A 65-year-old male with a history of severe chronic obstructive lung disease and prior laryngeal carcinoma was admitted to hospital due to fever. Five months before he was operated because of early-stage squamous cell lung carcinoma. Postoperative course was complicated with subcutaneous emphysema and recurrent pneumothorax. The appearance of new excavated lesions in the contralateral lobes on repeated chest computed tomography (CT) raised concern for tumor recurrence. Subsequent bronchoscopy with bronchoaspirate culture yielded Aspergillus niger. Molecular tests also showed positive findings for Aspergillus presence. First-line treatment with voriconazole resulted in significant clinical and radiological improvement. Positron emission tomography (PET-CT) done 6 months after voriconazole treatment showed only mild fluorodeoxyglucose (FDG) uptake in the right lower lobe, with no other areas of involvement This case highlights the importance of a multidisciplinary approach in lung cancer patients, where post-operative radiologic changes can represent tumor recurrence, bacterial infection or fungal disease.