Chronic Pulmonary Aspergillosis Misdiagnosed as Smear-Negative Pulmonary Tuberculosis in a TB Clinic in Nigeria
Titilola Gbaja Biamila *
Clinical Sciences Division, Nigerian Institute of Medical Research Yaba, Lagos, Nigeria
Felix Bongomin
National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK and Divison of Infection , Immunity and Respiratory Medicine, School of Biological Sciences , Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK and Department of Medical Microbiology & Immunology, School of Medicine, Gulu University, Gulu, Uganda
Nicholas Irurhe
Department of Radiology, College of Medicine, University of Lagos, Lagos, Nigeria
Augustina O. Nwosu
AIDS Prevention Initiative in Nigeria, Central Laboratory, College of Medicine of University of Lagos, Nigeria
Rita O. Oladele
Divison of Infection , Immunity and Respiratory Medicine, School of Biological Sciences , Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK and Department of Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
*Author to whom correspondence should be addressed.
Abstract
The clinical manifestations of chronic pulmonary aspergillosis (CPA) and pulmonary tuberculosis (PTB) are practically indistinguishable. We present a case of CPA in a 35-year-old HIV-negative trader, who had had three unsuccessful treatment courses for smear-negative PTB. He presented with a five-year history of recurrent symptoms suggestive of TB (haemoptysis, weight loss and productive cough). His sputum smear was acid-fast bacilli negative and GeneXpert analysis was negative for Mycobacterium tuberculosis. Chest X-rays revealed bilateral apical cavities and bullae. His Aspergillus-specific IgG tests were positive (>40 mg/L). He was managed with itraconazole 200mg twice daily with marked improvement in his clinical presentation and his quality of life after 4 months of therapy. However, he significantly deteriorated after discontinuing itraconazole for 1 month; he had adherence counselling and was re-commenced on long-term itraconazole therapy
Keywords: Chronic pulmonary aspergillosis, smear-negative TB, itraconazole Aspergillus IgG