Successful Lobectomy for Lung Aspergilloma Post–Tuberculosis Infection with Recurrent Hemoptysis

Abstract

Background: Aspergilloma is a colonization of a lung cavity by the fungus Aspergillus, which often occurs as a result of a prior tuberculous lesion. Diagnosis of aspergilloma is highly challenging due to limited sensitivity/specificity of diagnostic methods and potential false-negative serology/culture; thus, a multimodal approach combining antifungal therapy, debulking procedures, and pulmonary artery embolization is necessary and more effective at reducing recurrence and mortality.

Case: A male, 45-year-old, smoker, came with complaints of recurrent hemoptysis since one year ago, followed by shortness of breath. The patient had been diagnosed with tuberculosis twice, 10 years and 1 year ago confirm with bacteriologically, then was declared cured. CT scan thorax contrast concluded that pulmonary tuberculosis was inactive with a fungus ball at the apex of the left lung accompanied by multiple subpleural blebs. Surgery was carried out to remove the fungus ball and bullectomy. The results of the biopsy showed pieces of aspergillosis fungal tissue with a fungus ball appearance accompanied by necrosis. Postoperative treatment was given by voriconazole oral for 7 days and continued with itraconazole for 6 months according to PA results. The patient experienced clinical improvement and was able to return to activities during follow-up.

Conclusion: Surgery is a fairly effective treatment in cases of aspergilloma with recurrent hemoptysis. Surgical intervention allows for the complete removal of the fungal ball, the cavity it occupies, and the surrounding unhealthy lung tissue. Multidisciplinary and comprehensive treatment needs to be carried out to increase life expectancy and reduce recurring symptom.