Beyond the shadow: Chronic pulmonary aspergillosis imitating lung cancer on imaging

Pulmonary aspergillosis is a difficult diagnosis, especially among immunocompromised individuals, whose presentation overlaps with other benign respiratory illnesses like pneumonia or malignancy. We present a 53-year-old postmenopausal woman with a 20-day history of non-productive cough and periodic fever. Early investigations had rendered a differential diagnosis of malignancy and pneumonia, but subsequent imaging, bronchoscopy, and microbiological assessment resulted in a final diagnosis of aspergillosis. Histopathological specimens established the diagnosis of Aspergillus fumigatus, and antifungal treatment was instituted early. This case highlights the need for early suspicion and prompt treatment in susceptible patients with aspergillosis. An extensive patient history, in terms of the administration of immunosuppressive drugs and cancer treatment, is important to identify the increased risk for invasive aspergillosis. Radiologic and microbiologic studies continue to play an essential role in establishing the diagnosis, and prompt antifungal treatment is important to reduce the high morbidity and mortality from invasive fungal infections.