Five cases of pulmonary Aspergillus nodules diagnosed at surgery and by pathology in immunocompetent patients, with a literature review.

ABSTRACT

A pulmonary Aspergillus nodule is a rare subtype of chronic pulmonary aspergillosis. The diagnosis is difficult and is histological. There are only a few reports on such cases. Here, we report five cases of pulmonary Aspergillus nodules confirmed by surgery and pathology in immunocompetent patient and review the literature. Among the five patients in this group, three were females and two were males, aged 44-73 years old. Two cases had hemoptysis onset, and three cases were found to have a slow disease course on chest CT during imaging, ranging from months to years. The white blood cell count, carcinoembryonic antigen, and blood Galactomannan (GM) tests in five cases were all within normal range. Four cases had normal blood C-reactive protein, and one case had an increase. On imaging, there were two cases in the upper lobe of the right lung, two cases in the lower lobe of the left lung, one case in the upper lobe of the left lung, three cases were solitary nodular shadows, and two cases were nodular shadows with cavity formation, including one case with calcification, four cases with bronchial dilation shadows, and one case with gas containing cavity shadows. Five cases were treated with surgical resection and confirmed by histopathological examination. All five patients did not receive antifungal treatment after surgery, and there was no recurrence of Aspergillus nodules during regular follow-up.

Report 5 cases of pulmonary aspergillosis nodules confirmed by histopathology after surgical resection. Pulmonary aspergillosis nodules are a relatively rare manifestation in the spectrum of chronic pulmonary aspergillosis. This article reports five cases of pulmonary aspergillosis nodules confirmed by surgical resection and histopathological examination, all of which were patients with normal immune function, atypical clinical symptoms, varying severity, and normal Galactomannan (GM) tests. All five cases did not receive antifungal treatment after surgery, and the nodules did not recur during regular follow-up. The diagnosis of pulmonary aspergillosis nodules is difficult, and lung biopsy and bronchoalveolar lavage fluid (BALF) metagenomics next generation sequencing (mNGS) may be considered. There are various treatment methods, including surgical treatment, antifungal drug therapy, and sometimes local bronchial perfusion therapy can also be considered.