A case report on Aspergillus fumigatus causing pulmonary aspergillosis in an immunocompromised patient presenting as chronic obstructive pulmonary disease and pulmonary tuberculosis

Abstract

Pulmonary aspergillosis (PA) is a complicated fungal infection caused by aspergillus species, predominantly affecting immunocompromised individuals. This case highlights the diagnostic complexities as it often mimics other respiratory diseases like tuberculosis (TB) and chronic obstructive pulmonary disease (COPD) and in a patient with advanced HIV. Case presentation: A 48-year-old male with HIV (on third-line antiretroviral therapy, CD4 count 150 cells/μL) presented with a one-week history of cough, wheezing, shortness of breath, and fatigue. Initial management for COPD and bacterial infection provided minimal relief. Extensive diagnostic workup, revealed elevated Aspergillus-specific IgG antibodies (122 U/ml) and IgE levels (67.60 KUA/l). High-resolution computed tomography (HRCT) of the chest revealed bilateral bronchiectasis, suggestive of fungal infection, confirming PA. Conclusion: This case underscores the importance of considering opportunistic fungal infections like PA in immunocompromised patients with non-resolving respiratory symptoms, even when classic radiological signs are absent or overlap with other pulmonary conditions.