Semi-Invasive Aspergillosis in an Immunocompetent Host

A 54 year-old male patient was admitted to our clinic with dyspnea, dry cough and fever. Chest X-ray revealed pneumonic infiltration with air bronchograms involving all zones of right hemithorax. We observed radiological and clinical progress despite ceftriaxone, clarithromicin and bronchodilator for chronic obstructive pulmonary disease. The gram staining of bronchoalveolar lavage showed fungal septate hyphae. Cultures of sputum yielded Aspergillus fumigatus. The specimen of transthoracic fine-needle aspiration depicted tissue invasion by fungal hyphae and spores. Liposomal amphotericin B 150 mg/day was started and 40 mg/day metilprednisolone was initiated for bronchospasm. Under this treatment, patient’s clinical findings were improved. On the 21st hospital day, chest X-ray revealed abscess formation at the right upper and middle zones. Surgical treatment was not considered because of high postoperative high complication risk. Intracavitary 50 mg/day amphotericin was administered three times by a bronchoscopic catheter. On the 48th hospital day, respiratory distress, hypotension, bradycardia and juguler venous distension developed and patient was died.