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Pulmonary Aspergilloma in a Non-adherent Systemic Lupus Erythematosus Patient Receiving Long-Term Immunosuppression: A Report of a Rare Case

Summary

A patient with systemic lupus erythematosus (SLE), a chronic autoimmune disease treated with long-term immune-suppressing medications, developed a serious fungal lung infection called pulmonary aspergilloma. Despite the complexity of managing multiple conditions and extensive bilateral lung involvement, the patient was successfully treated with prolonged voriconazole antifungal therapy rather than surgery, emphasizing the importance of early recognition and tailored treatment in immunocompromised patients.

Background

Pulmonary aspergilloma is an uncommon but potentially life-threatening fungal infection affecting immunocompromised individuals with pre-existing lung disease. Systemic lupus erythematosus (SLE) patients on long-term immunosuppressive therapy have significantly increased susceptibility to opportunistic infections including Aspergillus species and other fungal pathogens.

Objective

To report a rare case of multilobar pulmonary aspergilloma in a 50-year-old woman with long-standing SLE and poorly controlled diabetes mellitus on chronic immunosuppressive therapy, highlighting diagnostic and therapeutic management challenges in this vulnerable population.

Results

Patient developed multilobar pulmonary aspergilloma with hemoptysis despite initial improvement on therapy. Diagnosis confirmed through radiological findings (air-crescent signs and cavitary lesions), elevated fungal biomarkers, and Giemsa staining. Successfully managed with prolonged voriconazole therapy (200 mg twice daily) for seven months, resulting in complete resolution of hemoptysis and sustained clinical stability.

Conclusion

This case underscores the importance of maintaining high clinical suspicion for fungal infections in immunocompromised hosts with chronic respiratory symptoms. Early diagnosis through integrated imaging, serology, and mycology combined with timely antifungal therapy is critical for optimal outcomes in complex immunosuppressed patients.
  • Published in:Cureus,
  • Study Type:Case Report,
  • Source: PMID: 40881570, DOI: 10.7759/cureus.88925
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