Unusual case of chronic cavitary pulmonary aspergillosis presenting as spontaneous pneumothorax in an immunocompromised man

Lung herniation post-removal of thoracostomy tube

A 30-year-old gentleman presented with complaints of fever, productive cough, and shortness of breath for 10 days. On presentation, he had a right intercostal drainage tube (ICD) in situ in view of chest radiograph findings where hydropneumothorax was suspected. He had a past history of pulmonary tuberculosis 3 years back for which he self-discontinued anti-tubercular therapy after 3 months. He was also diagnosed 2 years back with right pulmonary aspergilloma for which he was receiving anti-fungal therapy. Contrast-enhanced computed tomography (CECT) of the chest suggested right destroyed lung with multiple cavitations, ICD inserted in the right-sided lung cavity, and intracavitatory aspergilloma in the left lung. Hence, it was confirmed that the patient had a lung abscess with pus in a large cavity in the right lung which on chest radiograph had mimicked hydropneumothorax. The patient was subsequently diagnosed with a case of chronic cavitatory pulmonary aspergillosis, and the thoracostomy tube was removed. Post-tube removal, the patient developed lung herniation from the suture site which was confirmed on a CT scan for which the patient was successfully managed conservatively. Follow-up at 3 months did not reveal any evidence of lung herniation.

Efficacy of LD Bio Aspergillus ICT Lateral Flow Assay for Serodiagnosis of Chronic Pulmonary Aspergillosis

Background: The diagnosis of CPA relies on the detection of the IgG Aspergillus antibody, which is not freely available, especially in resource-poor settings. Point-of-care tests like LDBio Aspergillus ICT lateral flow assay, evaluated in only a few studies, have shown promising results for the diagnosis of CPA. However, no study has compared the diagnostic performances of LDBio LFA in setting of tuberculosis endemic countries and have compared it with that of IgG Aspergillus. Objectives: This study aimed to evaluate the diagnostic performances of LDBio LFA in CPA and compare it with existing the diagnostic algorithm utilising ImmunoCAP IgG Aspergillus. Methods: Serial patients presenting with respiratory symptoms (cough, haemoptysis, fever, etc.) for >4 weeks were screened for eligibility. Relevant investigations, including direct microscopy and culture of respiratory secretions, IgG Aspergillus, chest imaging, etc., were done according to existing algorithm. Serums of all patients were tested by LDBio LFA and IgG Aspergillus (ImmunoCAP Asp IgG) and their diagnostic performances were compared. Results: A total of 174 patients were included in the study with ~66.7% patients having past history of tuberculosis. A diagnosis of CPA was made in 74 (42.5%) of patients. The estimated sensitivity and specificity of LDBio LFA was 67.6% (95% CI: 55.7−78%) and 81% (95% CI: 71.9−88.2%), respectively, which increased to 73.3% (95% CI: 60.3−83.9%) and 83.9% (95% CI: 71.7−92.4%), respectively, in patients with a past history of tuberculosis. The sensitivity and specificity of IgG Aspergillus was 82.4% (95% CI: 71.8−90.3%) and 82% (95% CI: 73.1−89%); 86.7% (95% CI: 75.4−94.1%) and 80.4% (95% CI: 67.6−89.8%), in the whole group and those with past history of tuberculosis, respectively. Conclusions: LDBio LFA is a point-of-care test with reasonable sensitivity and specificity. However, further tests may have to be done to rule-in or rule-out the diagnosis of CPA in the appropriate setting.