Empyema Thoracis A Rare Presentation Of Aspergillus Infection

ABSTRACT

Introduction:The involvement of pleura in patients with allergic bronchopulmonary aspergillosis (ABPA) is uncommon.Aspergillus species is one of the most common causes of fungal infection of the lungs. Aspergillus empyema is a rare clinical entity and not included in classification of aspergillus related lung disease.Case Report A29 year old female patient with history of bronchial asthma, presented with fever, dry cough and right sided chest pain. On auscultation, the breath sounds were diminished in intensity over the right infrascapular area and diffuse wheeze was heard in the rest of the lung fields. Achest radiograph confirmed the presence of a right sided pleural effusion.On thoracocentesis, thick fluid was drained which was found to be exudative. She demonstrated immediate cutaneous hypersensitivity to Aspergillus fumigatus antigen.Both total Immunoglobulin E and A. fumigatus specific antibody were elevatedpatient was started on voriconazole and prednisolone. Patient started to clinically improve and radiological resolution started after 10 days.CONCLUSION:Tubercular Empyemas are a common presentation in Indian setting but empyema of fungal origin are rare. Hence a high index of suspicion is required to ensure timely diagnosis and treatment of this potentially lethal condition. Aspergillus is a rare cause of pleural effusion and must be thoroughly evaluated in patients with a history of asthma/ABPA