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Case Reports: Unusual presentation of more common disease/injury
Concomitant occurrence of advanced fibrocavitary pulmonary sarcoidosis and chronic pulmonary aspergillosis
  1. Si Yuan Khor1,
  2. Keerthi Gullapalli1,
  3. Akhil Sharma1 and
  4. Christopher Cantoria Garces1,2
  1. 1Department of Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
  2. 2Division of Rheumatology, University of Kansas Medical Center, Kansas City, Kansas, USA
  1. Correspondence to Dr Si Yuan Khor; khorsiyu{at}msu.edu

Abstract

An African American man in his 30s presented with haemoptysis associated with chronic productive cough, exertional dyspnoea, weight loss and skin lesions. Physical examination was notable for multiple cutaneous plaques over upper extremities and face. CT chest showed bilateral upper lobes cavitations and left upper lobe mass like consolidation. Further workup revealed positive serum aspergillus IgG, respiratory culture grew Aspergillus fumigatus, skin biopsy showed non-caseating granuloma. A final diagnosis of concomitant chronic pulmonary aspergillosis and advanced fibrocavitary pulmonary sarcoidosis with cutaneous involvement was made. The patient was initiated on antifungal therapy without steroids due to the concern of worsening the fungal infection. However, he presented later with worsening haemoptysis requiring bronchial artery embolisation. Surgical intervention was recommended but the patient eventually declined. The patient continued to be followed up closely in the clinic and repeated chest imaging showed stable findings 3 months after initial presentation.

  • Infections
  • Respiratory system
  • Pneumonia (infectious disease)
  • Pneumonia (respiratory medicine)

https://doi.org/10.1136/bcr-2022-250751

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    Footnotes

    • Contributors SYK wrote the initial draft and performed literature review. KG obtained consent, reviewed and edited final manuscript. AS reviewed and edited final manuscript. CCG reviewed and edited final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.