Invasive Pulmonary Aspergillosis in an Immunocompetent Patient Following Occupational Exposure to Iron Oxide Dust: A Long-Term Follow-Up Case Report

Purpose: Invasive pulmonary aspergillosis (IPA) is a life-threatening fungal infection that predominantly occurs in immunocompromised hosts. However, IPA may also develop in immunocompetent individuals following substantial environmental or occupational exposure, though such cases are rare and often underrecognized. To our knowledge, there are limited reports of IPA associated with iron oxide dust exposure in otherwise healthy individuals, and long-term follow-up data are scarce. Case Presentation: The patient was a 59-year-old male with no history of immunosuppression, who presented with cough, fever, and chest pain one week after heavy occupational inhalation of iron oxide dust. Initially misdiagnosed with bacterial pneumonia, he showed no improvement after empirical antibiotic therapy. Further investigation revealed purulent secretions on bronchoscopy; microbiological culture of sputum and bronchoalveolar lavage fluid grew Aspergillus fumigatus ; serological tests showed elevated galactomannan (index 1.47) and β-D-glucan (359 pg/mL); and initial chest computed tomography(CT) demonstrated bilateral multi-segmental infiltrates. Based on these findings, along with histopathological examination of lung tissue, the patient was diagnosed with invasive pulmonary aspergillosis. He was subsequently treated with voriconazole combined with caspofungin, along with a short course of glucocorticoids to modulate the inflammatory response. Follow-up CT at 10 years post-discharge showed complete radiological resolution of the pulmonary lesions. Results: The patient’s symptoms improved significantly after antifungal therapy. A follow-up chest CT at 10 years showed complete resolution of lung lesions without residual fibrosis or structural damage. Conclusion: This case highlights that IPA should be considered in immunocompetent patients with significant occupational or environmental exposures, even in the absence of classic risk factors. Early diagnosis through combined microbiological, serological, and histopathological evaluation is crucial. Long-term follow-up demonstrates that favorable outcomes can be achieved with appropriate antifungal therapy and patient adherence. Keywords: invasive pulmonary aspergillosis, immunocompetent, occupational exposure, iron oxide dust, long-term follow-up