title: Subacute invasive pulmonary aspergillosis as a rare cause of pneumothorax in immunocompetent patient: brief report.
abstract: Subacute invasive pulmonary aspergillosis (IPA) represents a form of chronic pulmonary aspergillosis which affects immunocompetent individuals or mildly immunocompromised persons with underlying pulmonary disease. Pneumothorax can be a rare complication of subacute IPA due to a leakage of air from an air-filled lung cavitation into the pleural space. Herein, we report rare and unusual case of pneumothorax in a patient with pulmonary cavity infection. A 40-year-old woman was admitted to thoracic surgery due to complete pneumothorax of the left lung. She was active smoker with untreated chronic obstructive pulmonary disease (COPD). After thoracic drainage multiple cavity forms in the both lungs were noticed. Galactomannan antigen was positive in bronchoalveolar lavage as well as culture of Aspergillus fumigatus. Antifungal treatment by voriconazole was started and continued during 6 months with a favorable outcome. This case highlights that subacute IPA is a diagnose that should be considered in patients with end-stage COPD, low body mass index, or patient who developed pneumothorax. The results of our case show that voriconazole is a safe and effective treatment as primary or salvage therapy in subacute forms of IPA, irrespective of the immunological status of the patients.
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia. abarac@jidc.org.|Clinic for Pulmonology, Clinical Centre of Serbia, Koste Todorovica 2, Belgrade, 11000, Serbia. abarac@jidc.org.
authors.forename: Tatjana Adzic
authors.initials: TA
authors.lastname: Vukicevic
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia.|Clinic for Pulmonology, Clinical Centre of Serbia, Koste Todorovica 2, Belgrade, 11000, Serbia.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Dudvarski-Ilic
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia.|Clinic for Pulmonology, Clinical Centre of Serbia, Koste Todorovica 2, Belgrade, 11000, Serbia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Zugic
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia.|Clinic for Infectious and Tropic Diseases, Clinical Centre of Serbia, Belgrade, Serbia.
authors.forename: Goran
authors.initials: G
authors.lastname: Stevanovic
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Rubino
authors.affiliation: Clinic for Infectious and Tropic Diseases, Clinical Centre of Serbia, Belgrade, Serbia.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Barac
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001232:Aspergillus fumigatus / Q000302:isolation & purification / Q000502:physiology; D005260:Female; D006801:Humans; D007121:Immunocompetence; D055744:Invasive Pulmonary Aspergillosis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008875:Middle Aged; D011030:Pneumothorax / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D016896:Treatment Outcome; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole
keywords: Aspergillus fumigatus; COPD; Pneumothorax; Subacute invasive pulmonary aspergillosis; Voriconazole