Chronic Nodular Pulmonary Aspergillosis in a Patient with Rheumatoid Arthritis

Abstract

Chronic pulmonary aspergillosis, which features nodular lesions known as Aspergillus nodules, is a relatively uncommon disorder. We herein report a case of slowly progressing chronic multiple nodular pulmonary aspergillosis in a 59-year-old man with rheumatoid arthritis, dyspnea, and fatigue. One nodule was surgically resected. The surgical specimen featured central necrosis and was located adjacent to a respiratory bronchiole and pulmonary artery, without parenchymal invasion. Branching septate hyphae, compatible with Aspergillus, were seen inside this necrotic nodule. Chronic pulmonary aspergillosis should therefore be considered in the differential diagnosis of patients who present with slowly progressing pulmonary multiple nodules.

Clinical Characteristics and Treatment Outcomes of Pathologically Confirmed Aspergillus Nodules

“…In addition, 90% (18/20) of the Aspergillus nodules for which data were available showed high SUV max uptake on FDG-PET/CT. As malignant nodules or granulomatous nodules, due to tuberculosis or nontuberculous mycobacteria, can show positive signals on PET [25], our data suggested that radiological imaging alone is unlikely to be useful for the differentiation of Aspergillus nodules from other etiologies [26]. Thorough investigations, including preoperative histological confirmation, should be considered before undertaking surgical resection to avoid unnecessary intervention or the misdiagnosis of benign conditions [9,26].…”

Pathological Diagnosis of Pulmonary Aspergillosis

“…Aspergillus nodules have been defined as one or more small nodules in the lungs (<3 mm in diameter), which may or may not cavitate. 12,24 Some authors have also included lesions that are slightly larger into the definition, 28,40 whereas others differentiate nodules bigger than 3 mm in size, with necrotic centers, as being Aspergillus mass lesions. 32 Macroscopically, Aspergillus nodules might be either smooth or lobulated, are sometimes calcified and may occasionally be associated with enlargement of the regional lymph nodes.…”

“…12,26,28 Due to this indistinguishabi-lity from other diseases, a definitive diagnosis is based on histological examination of biopsies and bronchoalveolar lavage fluid. 24,26 Histopathological manifestations of Aspergillus nodules include hyphal growth within granulomas/ pyogranulomas, with surrounding dense fibrous capsules 25,40,42 (►Fig. 7).…”

Chronic Pulmonary Aspergillosis: Literature Review and Demonstration of Own Observations

“…Описаны отдельные наблюдения множественных аспергиллезных узловых образований у пациентов с ревматоидным артритом [13,60], а также случаи сходства нодулярной формы ХАЛ с метастатическими инфильтратами [43].…”