Atypical presentation of pulmonary aspergilloma in an immunocompetent individual: a case study and clinical conundrum

Pulmonary aspergilloma typically develops in pre-existing lung cavities, while hemoptysis is the most recognized complication, spontaneous pneumothorax in immunocompetent patients is exceptionally rare. We report a case of a 58-year-old immunocompetent male who presented with acute respiratory distress due to spontaneous pneumothorax. Chest imaging revealed an aspergilloma with cavity rupture into the pleural space. Despite chest tube drainage, persistent pneumothorax necessitated surgical intervention. The patient underwent conservative thoracotomy and received six months of voriconazole therapy, achieving complete recovery. This case highlights an unusual presentation of pulmonary aspergilloma, emphasizing the importance of considering fungal etiology in post-tuberculosis patients presenting with pneumothorax.