PD. Azika*a (Mrs), GA. Desiantia (Mrs), RE. Sembiringb (Mrs)

a Department of Pulmonology and Respiratory Medicine Universitas Indonesia, Faculty of Medicine Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jakarta, INDONESIA ; b Department of Anatomical Pathology, Persahabatan National Respiratory Referral Hospital, Jakarta, INDONESIA

* diniazika@gmail.com

Background: Pleural aspergillosis is an uncommon manifestation of aspergillosis, that present in less than 5% of pleural effusion cases. Active or previous tuberculosis, bronchopleural fistulae, pleural drainage and lung resection are considered as the main predisposing conditions for Aspergillus infection in the pleural space. Pleural thickening has been described as an early manifestation of pulmonary aspergillosis. The diagnosis of pleural aspergillosis is confirmed by demonstration of the organism in pleural fluid or biopsy. However, this case has a high risk of mortality, mostly due to late or missed diagnosis or lack of effective treatment.

Case report: A 52-years-old male with the history of haemochromatosis with deferasirox for three years and previously treated as clinical lung tuberculosis (TB) for one year, came with chronic cough, dyspnoea and weight loss. Sputum acid-fast bacilli and potassium hydroxide smear were negative. High Resolution CT Thorax showed pleural effusion with multiple pleural calcification and thickening on lower hemithorax. Serial CT showed new multiple nodular lesion in the right pleura. Traction bronchiectasis, centrilobular, paraseptal emphysema, and bilateral lung honeycombing consistent with previous TB history. The patient was suspected as mesothelioma. Bronchoscopy showed hyperaemic and oedema of mucous membrane on right upper lobe. Pathological anatomy result from bronchial washing showed no malignancy. He underwent Trans Thoracic Needle Aspiration (TTNA) US-guided and cytological result showed necrotic debris, connective tissue fibers, and rod-shaped material Aspergillus fungi that consistent with aspergillosis.

Conclusion: Pleural aspergillosis is a rare manifestations of aspergillus infection. Aspergillus spp. infection should be considered in the differential diagnosis of such cases, particularly for those with a chronic lung disease.

Keyword: pleural aspergillosis, chronic lung disease

Disclosure of funding source(s): none