A rare case of calcified pulmonary aspergilloma
A 40-year-old male patient presented with cough with expectoration, and blood streaked sputum, which was intermittent for 2 years. He was diagnosed to have pulmonary tuberculosis 2 years ago for which he took treatment for 8 months. On examination, vitals were stable, and respiratory system examination revealed bronchial breath sounds in left upper lobe with crepitations. Routine blood examination showed eosinophilia and raised erythrocyte sedimentation rate (ESR) 20 mm/h. Chest X-ray revealed presence of left upper lobe cavity with accompanying air crescent []. Sputum for acid fast bacilli (AFB) smear was negative.\nBronchoscopy revealed white mass lesion occluding the apical posterior segment, which was hard and powdery on biopsy []. Histopathological examination of the biopsy specimen showed necrotic tissue fragments and fungal mass, composed of dichomatously branching, acute angled septate hyphae of Aspergillus. Calcified concretions were seen surrounding the debris and stained positive for periodic acid Schiff stain (PAS) []. There was no lymphoid tissue in the specimen to suggest broncholith due to erosion of calcified node within bronchus. Ziehl Neelson staining of the bronchial lavage showed presence of AFB. Cytology of bronchial brush showed few endobronchial cells, metaplastic squamous cells and occasional atypical cells. Many clusters of necrotic cells with histiocytes, neutrophils, and acute angled septate fungal hyphae were seen in a background of necrotic material and red blood cells (RBCs), suggestive of an abscess with aspergillosis. Based on the bronchoscopy findings and histopathology report, he was diagnosed to have calcified aspergilloma in the left upper lobe with active tuberculosis. Antitubercular treatment was restarted under DOTS Category II, with INH, rifampicin, pyrazinamide, ethambutol, and streptomycin.\nFollow up of the patient was done, and bronchoscopy repeated after one year revealed disappearance of the calcified mass. AFB smear and fungal smear of bronchial lavage were negative. Lung biopsy showed no evidence of fungal elements.