Aspergilloma

Abstract

A 25-year-old Sudanese man with a 1-month history of coughing up bloodstained sputum was referred to our facility. Six years earlier, he had had a similar episode lasting 5 weeks, during which he had also had night sweats, weight loss, and fatigue. At that time, he was treated empirically for tuberculosis. On presentation to our facility, he was afebrile, with normal oxygen saturation and breath sounds. Testing for the human immunodeficiency virus was negative. Chest radiography revealed a cavitary lesion in the left upper lobe (Panel A, arrow). A Mantoux test showed a 12-mm induration. Smear and culture results were negative for acid-fast bacilli. Chest computed tomography showed biapical cavities (Panels B and C, arrows) with a radiopaque, gravity-dependent ball (arrowheads) that moved inside the cavity in the supine (Panel B) and prone (Panel C) positions (Monad’s sign). Smear and culture results were positive for Aspergillus fumigatus. The patient received itraconazole for 6 months and has remained asymptomatic since that time, with no recurrent hemoptysis. Saprophytic aspergillosis results from colonization of a preexisting pulmonary cavity and typically leads to the formation of a fungus ball, or mycetoma, within the cavity. Although pulmonary mycetoma may be asymptomatic, patients can present with life-threatening hemoptysis.