Abstract
A 45-year-old woman occasionally had fever of unknown origin, headache, shift to the left of leukocytes, increase of blood sedimentation rate, positive CRP test and hypergammaglobulinemia from 5 years ago. She had high fever and marked increase of blood sedimentation rate one year ago and chest X-ray examination revealed an infiltrating lesion, approximately 1cm in diameter, in the upper field of the left lung. Under the diagnosis of pulmonary tuberculosis, antituberculous drugs (combination of isonicotinic acid hydrazide, ethambutol, streptomycin and rifampicin) with antibiotics were administered, but the lesion of the lung remained unchanged. Since bronchography disclosed three spindle-shaped bronchiectatic cavities, a lobectomy of upper lobe of the left lung replaced the antituberculous drug therapy.
Pathological examination of the resected lung tissue revealed that the cavitary lesions consisted of localized bronchiectasia containing Aspergillus hyphae in the lumen and associated with chronic inflammation surrounding fungal elements. In addition, some of their peripheral bronchioles were also filled with Aspergillus hyphae. However, no tuberculous lesion and bacilli were observed in the specimens.
It is considered that these findings may indicate primary broncho-pulmonary aspergillosis and a process to develop aspergilloma without antecedent cavity due to primary disease.
