Interstitial Lung Disease in Systemic
Scleroderma, Complicated with Bilateral
Pulmonary Aspergilloma:
An Unusual Association
Saumen Nandi, Avradip Santra, Loknath Ghoshal, Soumya Kundu
1. Assistant Professor, Department of Pulmonary Medicine, Nilratan Sircar Medical College & Hospital, Kolkata, West Bengal, India.
2. Residential Medical Officer (RMO) Cum Clinical Tutor, Department of Pulmonary Medicine, Nilratan Sircar Medical College & Hospital, Kolkata, West Bengal, India.
3. Assistant Professor, Department of Dermatology & Venereology, Nilratan Sircar Medical College & Hospital, Kolkata, West Bengal, India.
4. Demonstrator, Department of Pathology, Midnapore Medical College & Hospital, Paschim Medinipur, West Bengal, India.
Correspondence Address :
Dr. Avradip Santra,
15/1, Karar Pukur Lane, P.O.+Dist: Howrah, P.S.:Bantra, West Bengal-711101, India.
E-mail: dravradip@gmail.com
Abstract
Aspergilloma or mycetoma is a saprophytic fungal infection that colonizes pre-existing excavated lung lesion. However, its association with systemic sclerosis related interstitial lung disease is unusual and scarcely found in literature. We report a middle aged female with long standing systemic sclerosis, who was on immunosuppressive therapy for many years, presented with repeated haemoptysis. Although provisionally pulmonary tuberculosis was suspected, imaging investigations showed presence of bilateral masses inside bullous air spaces along with air-crescent sign suggestive of fungal ball. Subsequent Computed tomography guided needle aspiration from lung mass confirmed Aspergillus fumigatus as aetiologic agent on fungal culture. Patient was treated conservatively for haemoptysis and with oral antifungal drug as surgical removal of fungal ball was not an option due to poor pulmonary reserve. Although she had been treated with itraconazole for more than three years, she had recurrent haemoptysis during this period without any significant regression of size of the aspergilloma. Management of aspergilloma in a background of extensive interstitial lung disease remains poorly defined and complicated. Thereby, overall prognosis is unfavourable and depends on evolution of both underlying scleroderma as well as aspergilloma.
Keywords
Breathlessness, Recurrent haemoptysis, Systemic sclerosis
DOI and Others
DOI: 10.7860/JCDR/2015/15340.6926
Date of Submission: Jun 27, 2015
Date of Peer Review: Aug 24, 2015
Date of Acceptance: Oct 20, 2015
Date of Publishing: Dec 01, 2015
Financial OR OTHER COMPETING INTERESTS: None.