Chronic Nodular Pulmonary Aspergillosis in a Patient with Rheumatoid Arthritis

Chronic pulmonary aspergillosis, which features nodular lesions known as Aspergillus nodules, is a relatively uncommon disorder. We herein report a case of slowly progressing chronic multiple nodular pulmonary aspergillosis in a 59-year-old man with rheumatoid arthritis, dyspnea, and fatigue. One nodule was surgically resected. The surgical specimen featured central necrosis and was located adjacent to a respiratory bronchiole and pulmonary artery, without parenchymal invasion. Branching septate hyphae, compatible with Aspergillus, were seen inside this necrotic nodule. Chronic pulmonary aspergillosis should therefore be considered in the differential diagnosis of patients who present with slowly progressing pulmonary multiple nodules.

[1]  W. Lv,et al.  Clinical features and diagnosis of chronic pulmonary aspergillosis in Chinese patients , 2017, Medicine.

[2]  D. Denning,et al.  Aspergillus nodules; another presentation of Chronic Pulmonary Aspergillosis , 2016, BMC Pulmonary Medicine.

[3]  Catherine Beigelman-Aubry,et al.  Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management , 2015, European Respiratory Journal.

[4]  J. Goo,et al.  Pulmonary aspergillosis in immunocompetent patients without air-meniscus sign and underlying lung disease: CT findings and histopathologic features , 2011, Acta radiologica.

[5]  E. Veys,et al.  Bilateral spontaneous pneumothorax in a patient with pulmonary rheumatoid nodules, secondary infected by Aspergillus , 2007, Clinical Rheumatology.

[6]  C. Lengerke,et al.  Initial CT manifestations of invasive pulmonary aspergillosis in 45 non-HIV immunocompromised patients: association with patient outcome? , 2005, European journal of radiology.

[7]  G. Rossi,et al.  Fungus colonisation of pulmonary rheumatoid nodule , 2003, Journal of clinical pathology.

[8]  O. Woo,et al.  Pulmonary aspergillosis in immunocompetent hosts without underlying lesions of the lung: radiologic and pathologic findings. , 2002, AJR. American journal of roentgenology.

[9]  S. J. Kim,et al.  Semiinvasive pulmonary aspergillosis: CT and pathologic findings in six patients. , 2000, AJR. American journal of roentgenology.

[10]  A. Gibbs,et al.  Aspergillus colonization of pulmonary rheumatoid nodule. , 1989, Respiratory medicine.

[11]  T. Nagayasu,et al.  A case series of chronic necrotizing pulmonary aspergillosis and a new proposal. , 2013, Japanese journal of infectious diseases.

[12]  A. Haro,et al.  Aspergilloma mimicking a lung cancer. , 2013, International journal of surgery case reports.

[13]  R. Martins,et al.  Chronic necrotizing pulmonary aspergillosis. , 2009, Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia.

[14]  N. Müller,et al.  Semiinvasive pulmonary aspergillosis in chronic obstructive pulmonary disease: radiologic and pathologic findings in nine patients. , 2000, AJR. American journal of roentgenology.

[15]  K. O’Donnell.  Fusarium and its near relatives , 1993 .

[16]  T. White.  Amplification and direct sequencing of fungal ribosomal RNA genes for phylogenetics , 1990 .