A 69-year-old woman without any underlying diseases was admitted due to a dry cough and a high fever of several months’ duration. Chest computed tomography revealed scattered infiltrates and centrilobular nodules (Picture A). The serum level of Aspergillus antigen was elevated, but not that of nonspecific-IgE, Aspergillus precipitin, β-D glucan or anti-glycopeptidolipid-core IgA antibody. Bronchoscopy showed a blackish secretion, and Aspergillus niger (A. niger) was cultured (Picture B). No acid-fast bacilli were detected from the bronchoalveolar lavage fluid. Cryobiopsy specimens showed non-caseating epithelioid cell granulomas with Langhans giant cells and mild alveolitis (Picture C). Serum Aspergillus antigen turned negative after the administration of voriconazole. We diagnosed the patient to have chronic pulmonary aspergillosis with features of bronchocentric granulomatosis. Pulmonary aspergillosis usually occurs in cases where existing structures of the lung are destroyed and A. niger causes aspergillosis in immunocompromised hosts (1,2). The findings of this report suggest that A. niger may be a potential causative fungus of chronic pulmonary aspergillosis in immunocompetent patients.
Picture.
The authors state that they have no Conflict of Interest (COI).
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