[A rare case of huge aspergilloma developed within a lesion of pulmonary fibrosis secondary with a systemic scleroderma in an immunocompetent patient in Madagascar]

Bull Soc Pathol Exot. 2011 Dec;104(5):325-8. doi: 10.1007/s13149-011-0141-9. Epub 2011 Jun 22.
[Article in French]

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.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Aspergillus / physiology
  • Female
  • Humans
  • Immunocompetence* / physiology
  • Madagascar
  • Middle Aged
  • Mycetoma / complications
  • Mycetoma / diagnosis
  • Mycetoma / etiology*
  • Pulmonary Aspergillosis / complications
  • Pulmonary Aspergillosis / diagnosis
  • Pulmonary Aspergillosis / etiology*
  • Pulmonary Fibrosis / complications*
  • Scleroderma, Systemic / complications*
  • Tomography Scanners, X-Ray Computed