Successful surgery for pulmonary aspergillosis progressing to subacute process

A 59-year-old woman with diabetes and rheumatoid arthritis was given prednisolone following the diagnosis of rheumatoid lung disease. She developed fever and bloody sputum, and chest X-ray showed a massive shadow in the right lower lung field. Chest CT revealed a giant massive shadow with unclear margin in the right posterior lower lobe. With enhancement, a round low density area appeared in the shadow. Aspergillus hyphae were detected from a bronchial brushing specimen. Pulmonary aspergillosis was diagnosed administration of anti-fungal agents was commenced but the improvement was not satisfactory. Surgical resection, which may be curative, was subsequently performed. The resected lung contained an aspergillus ball formation within an enlarged bronchus, that is, a bronchial aspergilloma, surrounded by widespread inflammatory cell infiltration. Most pulmonary aspergillomas are of the "colonization type", but in our case progression to subacute process occurred according to the extent of our patient's immunological reaction. For the treatment of localized pulmonary aspergillosis, our results suggest that surgery is recommended.