Invasive Pulmonary Aspergillosis Presenting as a Giant Abscess in a Post-tuberculosis Destroyed Lung: A Case Report

Invasive pulmonary aspergillosis (IPA) is a severe fungal infection caused by Aspergillus mold, primarily affecting immunocompromised individuals, but increasingly seen in those with critical illness (e.g., viral infections) or in a subacute form in those with severe lung disease. We report the case of a 38-year-old woman with a history of pulmonary tuberculosis (TB) and a suspicion of post-TB chronic pulmonary aspergillosis who presented with dyspnoea and a productive cough unresponsive to antibiotics. Her condition rapidly evolved to respiratory insufficiency requiring intubation. Imaging revealed an extensive abscess in the left upper lobe with surrounding consolidation. Bronchoscopy showed a large amount of mucus requiring clearance. Cytopathology and cultures confirmed Aspergillus fumigatus (A. fumigatus). Laboratory testing showed marked eosinophilia, elevated total immunoglobulin-E, and positive A. fumigatus precipitins. The combination of a predisposing factor (post-tuberculosis cavities), cultures, and radiological findings was compatible with the diagnosis of subacute invasive pulmonary aspergillosis or chronic cavitating aspergillosis, as strictu sensu diagnosis of probable invasive aspergillosis could not be made (as typical immunocompromising host factors were not met). However, the disease was rapidly progressive, and the patient exhibited a good clinical, biochemical, and radiological evolution under voriconazole therapy. Long-term antifungal therapy will be required. This case highlights the importance of considering IPA, even in patients without classic profound immunosuppression, and recognizing post-tuberculosis cavities as a significant predisposing factor.