A Case Report :Pregnancy Complicated by Pulmonary Aspergillosis

Dr. Humaira Saeed Malik & Dr Catriona Barlow,  Dumfries & Galloway Royal Infirmary

Introduction

Chronic pulmonary aspergillosis (CPA) often caused by Aspergillus Fumigatus is a progressive, debilitating parenchymal lung disease manifesting in patients
with pre-existing cavitary, structural lung disease or those with subtle immune defects¹ Its clinical presentation and radiological features overlap substantially with the underlying diseases themselves.Hence, CPA can be easily neglected or misdiagnosed due to slow and insidious progression.²  Delayedor missed Aspergillus infection and ineffective treatment are responsible for mortality due to aspergillosis.³ 

Case Presentation

▪A 19-year-old, G2P1 woman presented at 22 weeks gestation with worsening breathlessness, pleuritic chest pain and recurrent hemoptysis. She had experienced similar symptoms during a previous pregnancy one year earlier.
▪CT thorax post partum revealed right lower lobe pulmonary aspergillosis and Aspergillus fumigatus IgG levels were elevated, confirming the diagnosis.
▪Her past medical history was notable for bronchiectasis secondary to meningococcal septicemia in early childhood, complicated by pneumonia requiring ECMO. Since then, she has had recurrent chest infections, managed with prophylactic antibiotics.

Managament

▪Multidisciplinary team (obstetricians, thoracic surgeons, respiratory physicians, infectious disease specialists, and interventional radiologists)involvement

▪Conservative: Antibiotics, tranexamic acid, close monitoring▪Bronchial artery embolization for hemoptysis at 29 weeks

▪Healthy baby delivered via planned C-section at 34+2 weeks

▪Persistent symptoms

▪Oral antifungal therapy initiated postpartum

▪Definitive management with successful right lower lobectomy 6 months later▪

Discussion

▪CPA often complicates existing lung pathology;

▪bronchiectasis was a keyrisk factor in this patient

▪Diagnosis is confirmed by imaging and serological evidence

▪Pregnancy complicates management: antifungal therapy delayed due to teratogenicity

▪Embolization is a temporizing measure; surgery deferred until postpartum

▪A multidisciplinary approach was critical in balancing maternal-fetal risks

 

Conclusion

This case highlights the complexity of managing CPA during pregnancy. Careful, tailored, multidisciplinary coordination enabled:

▪Stabilization with embolization

▪Planned preterm  delivery to mitigate maternal

▪Safe initiation of antifungal therapy postpartum

Surgical management remains the definitive treatment post-delivery

 

Key words

Pulmonary aspergillosis, Pregnancy, Aspergilloma, Hemoptysis, Bronchial artery embolization

 

References

1.Bongomin F, Asio LG, Baluku JB, Kwizera R, Denning DW. Chronic pulmonary aspergillosis: notes fo a clinician in a resource-limited setting where there is no mycologist. Journal of Fungi. 2020 Jun 2;6(2):75.

2.Ma, X., Wang, K., Zhao, X. et al. Prospective study of the serum Aspergillus-specific IgG, IgA and IgM assays for chronic pulmonary aspergillosis diagnosis. BMC Infect Dis 19, 694 (2019). https://doi.org/10.1186/s12879-019-4303-x

3.Chinnasamy S, Sundararajan L, Radhakrishnan C, Nambi PS. Pleuropulmonary aspergillosis presenting as hydropneumothorax in second trimester pregnancy. Indian J Respir Care 2019;8:57-9.

 

Contact details 

Humaira Saeed malik  email  humdr16@gmail.com