30 AJTCCM VOL. 30 NO. 1 2024
PICK OF THE PICS
A 50-year-old male with advanced HIV
infection and previously treated pulmonary
tuberculosis (TB) presented to hospital
with a nine-month history of constitutional
symptoms, non-productive cough, and
worsening dyspnea. Multiple sputa samples
over the preceding nine months were culture-
negative for TB.
A chest radiograph revealed an ill-
defined opacity in the right upper lobe
with associated pleural thickening (Fig.
1). Computer-tomography chest imaging
demonstrated a cavity in the right upper lobe
with associated intracavitary lesions (Fig. 2).
e clinical history and radiological ndings
were consistent with a diagnosis of chronic
cavitary pulmonary aspergillosis (CCPA).[1]
Blood serology and a fungal culture of sputa
conrmed both exposure and active growth
of Aspergillus fumigatus.
After an initial two-week regimen of
intravenous Amphoteracin B the patient was
commenced on long-term oral voriconazole
therapy.
At a six-week follow up, he reported
significant resolution of his constitutional
symptoms and radiological improvement
was seen on a repeat chest radiograph. Close
clinical follow up is planned.
1. Denning DW, Cadranel J, Beigelman-Aubry C.
Chronic pulmonary aspergillosis: rationale and
clinical guidelines for diagnosis and management.
European Respiratory J 2015;47(1):45-68. https://doi.
org/10.1183/13993003.00583-2015.
What potentially treatable opportunistic mould could be the cause
of the patients’ breathlessness?
S Brunke, MB ChB (Stell); L D Hunter, MB ChB (Stell) PhD; A T Mnguni, MB ChB (UCT), MMed (Int), FCP (SA), Cert Pulmonology
(SA) Phys
Department of Internal Medicine, Khayelitsha District Hospital and Faculty of Health Sciences University of Stellenbosch. Western Cape, South Africa
Corresponding author: S Brunke (stef.brunke@outlook.com)
Fig. 2. Computer-tomography chest imaging
demonstrating a cavity in the right upper lobe
with associated intra-cavity lesion.
A B
Fig. 1 (A). Chest radiograph on admission to hospital and (B) Follow-up imaging aer six weeks
of voriconazole therapy.
