title: [A rare case of huge aspergilloma developed within a lesion of pulmonary fibrosis secondary with a systemic scleroderma in an immunocompetent patient in Madagascar].
abstract: We report a rare case of a huge aspergilloma developed within a bronchiectasis due to pulling by a pulmonary fibrosis of systemic scleroderma. The patient is a 58-year-old woman presenting a deterioration of the general state associated with repeating hemoptysis, dyspnea, dysphagia, sclérodactylia, generalized cutaneous sclerosis and Raynaud's phenomenon. There was no antecedent pulmonary tuberculosis. The patient had a pulmonary arterial hypertension complicated by a chronic pulmonary heart at the stage of right cardiac decompensation. Aspergillosis serology was positive and the immunological assessment confirmed scleroderma. The computed tomography showed a huge oblong opacity in a small round bell shape ("signe du grelot", Monad's sign) in the left upper lobe developed within a bronchiectasis, and a bilateral pulmonary fibrosis. Although surgery remains the recommended treatment of an aspergilloma, the management of our patient was medical in front of contra-indication for surgery. The evolution was marked by repeating hemoptysis and stability of the pulmonary lesions 2 years later. The management of this entity remains difficult and complicated; the prognosis is in general unfavourable and depends at the same time on the evolution of scleroderma and the aspergilloma infection.
authors.affiliation: Centre Hospitalier Universitaire d'Antananarivo, Antananarivo, Madagascar. jrakotoson@yahoo.fr
authors.forename: J L
authors.initials: JL
authors.lastname: Rakotoson
authors.forename: H M D
authors.initials: HM
authors.lastname: Vololontiana
authors.forename: R E
authors.initials: RE
authors.lastname: Raherison
authors.forename: R
authors.initials: R
authors.lastname: Andrianasolo
authors.forename: J R
authors.initials: JR
authors.lastname: Rakotomizao
authors.forename: M J D
authors.initials: MJ
authors.lastname: Randria
authors.forename: R F
authors.initials: RF
authors.lastname: Rapelanoro
authors.forename: A C F
authors.initials: AC
authors.lastname: Andrianarisoa
authors.forename: H R
authors.initials: HR
authors.lastname: Rajaona
mesh_terms: D001230:Aspergillus / Q000502:physiology; D005260:Female; D006801:Humans; D007121:Immunocompetence / Q000502:physiology; D008270:Madagascar; D008875:Middle Aged; D008271:Mycetoma / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D055732:Pulmonary Aspergillosis / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D011658:Pulmonary Fibrosis / Q000150:complications*; D012595:Scleroderma, Systemic / Q000150:complications*; D015898:Tomography Scanners, X-Ray Computed