A MYCETOMA IN A GENTLEMAN WITH CHURG-STRAUSS SYNDROME

Amit Tanna, Jo Han Yeoh

Abstract


Pulmonary aspergilloma (mycetoma) is a rare pulmonary infectious disease that manifests clinically with fever, chest pain, chronic cough and haemoptysis, although may be asymptomatic in some patients [1].

Here, a case is presented of an elderly gentleman attending hospital coughing up blood-stained sputum.  Thoracic computed tomography (CT) revealed a left apical lung cavity with a mycetoma, presumed secondary to an aspergillus infection.  The fungal ball dropped anteriorly within the cavity when the patient lay on his front, hence confirming the diagnosis.  The haemoptysis settled with Itraconazole; anti-fungals being the treatment-of-choice in symptomatic individuals with a pulmonary aspergilloma.

This gentleman also suffered from severe Churg-Strauss syndrome and required long-term triple immuno-suppressive therapy.  Pulmonary aspergillosis is a serious threat to those immuno-compromised as a result of disease or treatment [2].  This case highlights the importance of considering a mycetoma as a cause for respiratory symptoms in immuno-compromised individuals, especially in those presenting with haemoptysis.


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