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<p>Chronic pulmonary aspergillosis (CPA) is often misdiagnosed as tuberculosis (TB) in Nigeria, thus warranting unnecessary initiation of anti-Kochs treatment. Therefore, we must drive awareness of CPA in our setting to improve clinical outcomes and invariably reduce morbidities from this clinical entity. A 30-year-old man presented with symptoms of recurrent cough and difficulty in breathing for a 1-year duration. The patient was commenced on anti-tuberculosis medications despite having a negative GeneXpert result and had no improvement while receiving anti-TB treatment. Radiological findings from chest X-ray and chest CT scan also suggested a diagnosis of TB, and as such was initially considered as a case of pulmonary TB. However, the <i>Aspergillu</i>s IgG assay returned positive and sputum culture yielded <i>Aspergillus fumigatus</i> and <i>Aspergillus flavus</i> which confirmed a diagnosis of CPA. Anti-Kochs regimen was discontinued and itraconazole commenced at 200&#xa0;mg twice daily. The presenting symptoms resolved, and the patient was seen to have returned to a state of good health. A diagnosis of CPA should be considered in an unconfirmed TB patient, especially in a setting that is rife with TB. Training and retraining healthcare workers on the recognition of fungal diseases and the availability of fungal diagnostics would be invaluable in improving the diagnosis of CPA.</p>

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Delayed Diagnosis of Chronic Pulmonary Aspergillosis in a Nigerian: A Concern for an Attending Clinician in a Tuberculosis Rife Setting

  • 期刊论文

  • 发表日期：

    2025年3月1日

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  • Bassey E. Ekeng,
  • Ako H. Itam,
  • Anthony Offiong,
  • Bernard Monjol,
  • Utibe G. Thompson,
  • Ubong A. Udoh,
  • Rita O. Oladele

摘要

Chronic pulmonary aspergillosis (CPA) is often misdiagnosed as tuberculosis (TB) in Nigeria, thus warranting unnecessary initiation of anti-Kochs treatment. Therefore, we must drive awareness of CPA in our setting to improve clinical outcomes and invariably reduce morbidities from this clinical entity. A 30-year-old man presented with symptoms of recurrent cough and difficulty in breathing for a 1-year duration. The patient was commenced on anti-tuberculosis medications despite having a negative GeneXpert result and had no improvement while receiving anti-TB treatment. Radiological findings from chest X-ray and chest CT scan also suggested a diagnosis of TB, and as such was initially considered as a case of pulmonary TB. However, the Aspergillus IgG assay returned positive and sputum culture yielded Aspergillus fumigatus and Aspergillus flavus which confirmed a diagnosis of CPA. Anti-Kochs regimen was discontinued and itraconazole commenced at 200 mg twice daily. The presenting symptoms resolved, and the patient was seen to have returned to a state of good health. A diagnosis of CPA should be considered in an unconfirmed TB patient, especially in a setting that is rife with TB. Training and retraining healthcare workers on the recognition of fungal diseases and the availability of fungal diagnostics would be invaluable in improving the diagnosis of CPA.