P107 | Chronic pulmonary aspergillosis: a difficult diagnosis in an apparent immunocompetent patient

M. Novelli, L. Ramadori | ASL TO4, Torino, Italy

Premises: Aspergillosis is an infection caused by a fungus.
Description of the Case report: An 84 years old man, was admitted for pulmonary thromboembolism. The patient was discharged with indication to be treated with rivaroxaban. Again he was hospitalized because of respiratory progressive decline. Thrombophilia profile was positive for hyperhomocysteinemia. Thoracic angioCT scan showed increased thromboembolic depositions. He had always normal hematic exams including inflammation markers. We discharged him with warfarin and folic acid. At September 2022 the patient was re-admitted. Thoracic angioCT scan showed increased thromboembolic depositions. An heterogenous parenchymal consolidation appeared. Bronchopsy was negative for endobronchial lesions. Aspergillus essay was positive. Coltural exam on sputum was positive for Candida albicans. Echocardiography excluded endocarditis. HRTC was repeated and it showed increased volume of the right superior lobar cavity and hyperdense content. The infectious disease specialist recommended us to use voriconazole instead of caspofungin. Due to increased pleural essudate, a drainage tube was set, but the procedure was complicated by hydropneumothorax. Pneumological evaluation attributed the context of the hydropneumothorax to the presence of a pulmonary fistula replenishing the hydropneumothorax. Due to the poor general conditions of the patient was initiated to the palliative cure treatment.
Conclusions: Aspergillosis involves mildly immunosuppressed patients, indeed our patient didn’t show immunodepression risk factors.