Nonfibrotic Hypersensitivity Pneumonitis Complicated by Chronic Progressive Pulmonary Aspergillosis : A Case Report

• Published in: THE SHINSHU MEDICAL JOURNAL Vol. 71; no. 4; pp. 235 - 240
• Main Authors: KANAYAMA, Risa, WADA, Yosuke, TATEISHI, Kazunari, KITAGUCHI, Yoshiaki, USHIKI, Atsuhito, HANAOKA, Masayuki
• Format: Journal Article
• Language: English; Japanese
• Published: The Shinshu Medical Society 10.08.2023
• Subjects: bronchoscopy; chronic cavitary pulmonary aspergillosis; chronic progressive pulmonary aspergillosis; nonfibrotic hypersensitivity pneumonitis; voriconazole
• ISSN: 0037-3826; 1884-6580
• DOI: 10.11441/shinshumedj.71.235

Diagnosis of chronic pulmonary aspergillosis in patients with nonfibrotic hypersensitivity pneumonitis is difficult, especially after treatment with systemic corticosteroids has been initiated. Therefore, treatment for chronic progressive pulmonary aspergillosis (CPPA) is often delayed. Although the chief complaint of non-fibrotic hypersensitivity pneumonitis complicated by pulmonary aspergillosis is often fever, the fungus cannot be identified, even after repeated sputum culture tests. Herein, we report a case of pulmonary aspergillosis that developed after initiating treatment with systemic corticosteroids and was difficult to diagnose. The patient had a fever that continued after the introduction of steroids. CPPA was eventually diagnosed based on histopathological examination of a bronchoscopy sample. When CPPA is suspected in patients with hypersensitivity pneumonitis, bronchoscopy may improve their prognosis.