Invasive mediastinal aspergillosis presenting as superior vena cava syndrome in an immunocompetent patient

BMJ Case Rep. 2018 Sep 12:2018:bcr2018225614. doi: 10.1136/bcr-2018-225614.

Abstract

Invasive aspergillosis (IA) is a disease of the immunocompromised with a predilection for the lungs, although dissemination to all organs is possible. Its diagnosis remains a challenge due to the absence of specific clinical manifestations and laboratory findings. In most cases, diagnosis is eventually made via invasive methods. It carries with it a high mortality due to late diagnosis and delayed treatment. Here, we report a fascinating case of a young, otherwise healthy, immunocompetent patient that presented to us with superior vena cava syndrome and a mediastinal mass. It was anticipated that a malignancy would be found on further workup but, in fact, what was eventually discovered was a case of IA. Our report accentuates the significance of including IA as a differential while diagnosing a mediastinal mass in an immunocompetent host as patient outcome is determined by timely diagnosis and treatment.

Keywords: Tb and other respiratory infections; lung cancer (oncology).

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antifungal Agents / therapeutic use
  • Aspergillosis / diagnosis*
  • Aspergillosis / drug therapy
  • Aspergillus flavus / isolation & purification
  • Diagnosis, Differential
  • Humans
  • Immunocompetence
  • Male
  • Mediastinal Diseases / diagnosis*
  • Mediastinal Diseases / drug therapy
  • Mediastinal Diseases / microbiology
  • Mediastinum
  • Superior Vena Cava Syndrome / diagnosis*

Substances

  • Antifungal Agents