Pulmonary Aspergilloma Co-Existing with Pulmonary Tuberculosis: A Case Report in Type 1 Diabetes Mellitus (T1DM) Patient
Downloads
Introduction: Pulmonary aspergilloma is a disease frequently found in immunocompromised patients. In Indonesia, around 18% of diabetes mellitus (DM) patients suffer from chronic pulmonary aspergilloma. However, data on type 1 DM (T1DM) are still limited.
Case: We presented the case of a 22-year-old male admitted to the emergency room due to hemoptysis of approximately 200 ml within six hours before admission, nonspecific chest pain during cough, fever, night sweats, and weight loss of 3 kg over the last months. The patient had a history of T1DM and no prior history of respiratory diseases. Physical examination showed tachycardia, tachypnoea, subfebrile, normal body mass index, and rhonchi on the left thorax. Routine laboratory tests revealed increased blood sugar level (503 mg/dL) and HbA1c 16.4%. Chest X-ray and high-resolution computed tomography (HRCT) showed a cavity with an opaque lesion, crescent sign, consolidation, and reticulonodular infiltrate on the left lung. Rapid molecular tests, tuberculosis (TB), and serum galactomannan (GM) were negative. The patient was diagnosed with pulmonary aspergilloma, T1DM, and clinical TB. He was treated with fluconazole, insulin, and a fixed-dose combination of anti-TB. The patient refused the surgery procedure. Immediately, the hemoptysis stopped, blood glucose level was normal, and concomitant with weight gain.
Conclusion: Due to innate and acquired immunity impairment, T1DM is a risk factor for pulmonary infections, including TB and pulmonary aspergilloma. Chest HRCT may help diagnose fungal balls. Though the patient refused to undergo surgery, administering antifungal, anti-TB drugs, and glucose control as initial treatment presented a good prognosis in the patient.
Setianingrum F, Rozaliyani A, Jusuf A, et al. Pulmonary Mycoses in Indonesia: Current Situations and Future Challenges. J Respirologi Indones 2019; 39: 211–215.
Lin J, Feng B, Tang H, et al. A Systematic Review and Meta-Analysis: Pulmonary Mycosis Pathogen Distribution. Ann Palliat Med 2021; 10: 7919–7932.
Batzlaff CM, Limper AH. When to Consider the Possibility of a Fungal Infection: An Overview of Clinical Diagnosis and Laboratory Approaches. Clin Chest Med 2017; 38: 385–391.
Li Z, Lu G, Meng G. Pathogenic Fungal Infection in the Lung. Front Immunol 2019; 10: 1524.
Setianingrum F, Rozaliyani A, Adawiyah R, et al. A Prospective Longitudinal Study of Chronic Pulmonary Aspergillosis in Pulmonary Tuberculosis in Indonesia (APICAL). Thorax 2022; 77: 821–828.
Lachmandas E, Thiem K, van den Heuvel C, et al. Patients with Type 1 Diabetes Mellitus Have Impaired IL-1β Production in Response to Mycobacterium tuberculosis. Eur J Clin Microbiol Infect Dis 2018; 37: 371–380.
(PDPI) PDPI. Mikosis Paru. In: Rozaliyani A, Jusuf A, Handayani D, et al. (eds) Pedoman Nasional untuk Diagnosis dan Penatalaksanaan di Indonesia. Jakarta, 2017.
Kanj A, Abdallah N, Soubani AO. The Spectrum of Pulmonary Aspergillosis. Respir Med 2018; 141: 121–131.
Denning DW, Cadranel J, Beigelman-Aubry C, et al. Chronic Pulmonary Aspergillosis: Rationale and Clinical Guidelines for Diagnosis and Management. Eur Respir J 2016; 47: 45–68.
Alastruey-Izquierdo A, Cadranel J, Flick H, et al. Treatment of Chronic Pulmonary Aspergillosis: Current Standards and Future Perspectives. Respiration 2018; 96: 159–170.
Ketai L, Currie BJ, Holt MR, et al. Radiology of Chronic Cavitary Infections. J Thorac Imaging 2018; 33: 334–343.
Bongomin F, Asio LG, Baluku JB, et al. Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There is no Mycologist. J Fungi (Basel, Switzerland); 6. Epub ahead of print June 2020.
Iqbal N, Irfan M, Mushtaq A, et al. Underlying Conditions and Clinical Spectrum of Chronic Pulmonary Aspergillosis (CPA): An Experience from a Tertiary Care Hospital in Karachi, Pakistan. J Fungi (Basel, Switzerland); 6. Epub ahead of print March 2020.
Denning DW, Page ID, Chakaya J, et al. Case Definition of Chronic Pulmonary Aspergillosis in Resource-Constrained Settings. Emerg Infect Dis; 24. Epub ahead of print August 2018.
Aldiani A, Alatas MF. Pathophysiology of Haemoptysis in Lung Disease. J Respirologi Indones 2023; 43: 58–65.
Duong TB, Ceglar S, Reaume M, et al. Imaging Approach to Cavitary Lung Disease. Ann Am Thorac Soc 2020; 17: 367–371.
Parkar AP, Kandiah P. Differential Diagnosis of Cavitary Lung Lesions. J Belgian Soc Radiol 2016; 100: 100.
Kosmidis C, Denning DW. The Clinical Spectrum of Pulmonary Aspergillosis. Thorax 2015; 70: 270–277.
Davda S, Kowa X-Y, Aziz Z, et al. The Development of Pulmonary Aspergillosis and Its Histologic, Clinical, and Radiologic Manifestations. Clin Radiol 2018; 73: 913–921.
Shin B, Koh W-J, Jeong B-H, et al. Serum Galactomannan Antigen Test for the Diagnosis of Chronic Pulmonary Aspergillosis. J Infect 2014; 68: 494–499.
Sehgal IS, Dhooria S, Choudhary H, et al. Utility of Serum and Bronchoalveolar Lavage Fluid Galactomannan in Diagnosis of Chronic Pulmonary Aspergillosis. J Clin Microbiol; 57. Epub ahead of print March 2019.
Patterson TF, Thompson GR, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 63: e1–e60.
Lang M, Lang AL, Chauhan N, et al. Non-Surgical Treatment Options for Pulmonary Aspergilloma. Respir Med 2020; 164: 105903.
Lamoth F, Calandra T. Pulmonary Aspergillosis: Diagnosis and Treatment. Eur Respir Rev 2022; 31: 220114.
Copyright (c) 2023 Widya Tria Kirana, Hana Khairina Putri Faisal, Hiroki Kitagawa, Gigih Setiawan, Faisal Yunus
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
1. The journal allows the author to hold the copyright of the article without restrictions.
2. The journal allows the author(s) to retain publishing rights without restrictions.
3. The legal formal aspect of journal publication accessibility refers to Creative Commons Attribution Share-Alike (CC BY-SA).
4. The Creative Commons Attribution Share-Alike (CC BY-SA) license allows re-distribution and re-use of a licensed work on the conditions that the creator is appropriately credited and that any derivative work is made available under "the same, similar or a compatible license”. Other than the conditions mentioned above, the editorial board is not responsible for copyright violation.
JR (