title: Pleural aspergillosis with bronchopleurocutaneous fistula and costal bone destruction: a case report.
abstract: A 65-year-old man who, when young, had had tuberculosis treated by therapeutic pneumothorax, consulted his family physician for a constitutional syndrome and dyspnea. At this time radiologic studies showed left pleural effusion with bilateral calcified plaques, an infiltrate in the upper left lobe, and a picture compatible with aspergilloma, all suggesting semi-invasive aspergillosis. The patient failed to show up for his followup visit, so no therapy could be started or further diagnostic tests ordered. One month later he was admitted to this hospital for a bronchopleural fistula (empyema necessitatis) with subsequent spontaneous hydropneumothorax and costal bone involvement. The patient underwent surgery because of his rapid worsening condition. Biopsy examination revealed a large pleural aspergilloma. Despite immediate antifungal therapy, the patient died. We believe this to be the first report of pleural Aspergillus with a bronchopleurocutaneous fistula and costal bone destruction.
authors.affiliation: Pneumology Service, Carlos Haya Hospital, Malaga, Spain. enriquesoto40@hotmail.com
authors.forename: Enrique J
authors.initials: EJ
authors.lastname: Soto-Hurtado
authors.forename: Ester
authors.initials: E
authors.lastname: Marín-Gámez
authors.forename: Nuria
authors.initials: N
authors.lastname: Segura-Domínguez
authors.forename: Francisco
authors.initials: F
authors.lastname: Jiménez-Oñate
mesh_terms: D000368:Aged; D001228:Aspergillosis / Q000150:complications*; D001842:Bone and Bones / Q000473:pathology; D001983:Bronchial Fistula / Q000150:complications*; D017577:Cutaneous Fistula / Q000150:complications*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D035422:Pleural Cavity / Q000382:microbiology*; D010995:Pleural Diseases / Q000150:complications* / Q000382:microbiology; D010996:Pleural Effusion / Q000000981:diagnostic imaging; D011859:Radiography; D016156:Respiratory Tract Fistula / Q000150:complications*