Invasive pulmonary aspergillosis masquerading as recurrent tuberculosis in a patient with persistent hemoptysis: A case report

Background: Chronic pulmonary aspergillosis is increasingly being diagnosed in Nigeria due to the thriving awareness of fungal infections and efforts to improve fungal diagnostics. However, much still needs to be done as cases of Chronic pulmonary aspergillosis are being misdiagnosed as tuberculosis with attendant problems including unnecessary initiation of anti-tuberculosis therapy, delay of appropriate diagnosis, economic losses and worsening morbidity. These challenges typified this case report, a 40-year-old woman with complaints of recurrent haemoptysis of 10 years duration. She had been treated for pulmonary tuberculosis 20 years ago after which she was affirmed to be acid-fast bacilli negative and cured of TB. On presenting at a peripheral centre, anti-tuberculosis regimen was repeated despite lacking evidence of a diagnosis of tuberculosis. She failed to improve with this second tuberculosis treatment. She was referred to the University of Calabar Teaching Hospital where a diagnosis of chronic pulmonary aspergillosis was made following a positive Aspergillus immunoglobulin G and galactomannan assay and chest radiological findings suggestive of pulmonary aspergillosis. She was commenced on itraconazole dosage of 200mg b.d and observed to have improved with the resolution of hemoptysis. Post-tuberculosis-treated patients should be routinely investigated for Chronic pulmonary aspergillosis, and appropriate and timely treatment initiated where necessary.