P6‐24: co‐existence of active pulmonary tuberculosis and aspergilloma‐ a rare entity

Introduction: Aspergillus colonising a pre-existing parenchyma lung cavity is referred to as Aspergilloma.11-17% of patients with post TB cavities have been reported with aspergilloma. Most common manifestation is haemoptysis and is seen in 50-90% of the patients. History and Presentation: A 50 years-old male, agricultural labourer by occupation, a chronic smoker and treated case of PTB, was admitted with cough with dirty white to yellowish mucopurulent expectoration and recurrent episodes mild-moderate hemoptysis for the past 3 months. He had no known co-morbidities. General examination revealed pallor and on chest auscultation there was bronchial breath sounds in the right supraclavicular and infraclavicular areas with coarse crepitations. Diagnosis and Management: Chest Xray revealed right upper zone cavity with non-homogenous opacities. HRCT showed right upper lobe thick walled cavity with intracavitary soft tissue density rounded mass suggestive of aspergilloma. Sputum investigation were negative. Surgery was planned after routine evaluation. Right upper lobectomy was done through right parasternal thoracotomy. Surgical specimen histopathological examination showed areas of extensive necrosis with numerous entangled fungal hyphae, septate with acute angle branching consistent with aspergillosis and areas of extensive caseous necrosis with giant cell reactions and dense inflammatory infiltrate forming lymphoid aggregates suggestive of active pulmonary TB. Biopsy specimen subjected to mycobacterial culture grew MTB with no resistance on DST. Post-op period was uneventful. Patient was initiated on ATT, has completed intensive phase and is on regular follow up. Conclusion: Pulmonary aspergilloma usually occurs in old ‘healed’ pre-existing tuberculous cavity. Co-existence of active TB and aspergilloma has rarely been reported in the literature. However, TB relapse in a patient with aspergilloma should be ruled-out and management has to be planned accordingly.