PULMONARY TUBERCULOSIS WITH

CHRONIC PULMONARY ASPERGILOSIS

Firda Widasari1, Bambang Sigit Riyanto2
1
Departement of Internal Medicine, Faculty of Medicine, Public Health, and Nursing
Gadjah Mada University/Dr. Sardjito Hospital, Yogyakarta, Indonesia
2
Division of Pulmonology, Departement of Internal Medicine, Faculty of Medicine, Public Health, and Nursing
Gadjah Mada University/Dr. Sardjito Hospital, Yogyakarta, Indonesia

Introduction
Chronic pulmonary aspergillosis (CPA) is an uncommon pulmonary disease,
complicating many other respiratory disorders, The form of CPA are chronic cavitary
pulmonary aspergillosis (CCPA), Aspergillus nodule and aspergilloma. All these entities are
found in non-immunocompromised patients with prior or current lung disease. We reported a
patient with chronic pulmonary aspergillosis concomittant with pulmonary tuberculosis treated
with ketoconazole and antituberculosis therapy.

Case Report
An Indonesian Man, 51 years old, presented with cough productive with one episode
haemoptysis one day before admission. He also complained dispneu since 2 months and worsen
in 1 month before admission and significat wight loss. Patient had no fever, neither chest pain,
nor night sweats. Chest CT result was pulmonary active TB with suspect aspergilloma but Gen
xpert sputum for mycobacterium tuberculosis was negative. Recommendation drug for
aspergilosis is voriconazole which is available at high cost, so this patient treated with one of
sensitive drug based on biopsy culture, ketoconazole (for 12 weeks) with standard regimen for
tuberculosis. After 12 weeks treatment he had a 7-kg weight gain and total resolution of his
sign and symptoms. After 6 months of observation, recent Chest CT still showed an
aspergilloma but no symptoms at all.

Discussion
The management of CPA presents multiple challenges. Treatment with oral
antifungals is the mainstay, but is often prolonged, resulting in significant side effects, cost and
development of resistance. Most patients with aspergilloma are asymptomatic, they may not
need treatment and can be observed conservatively.

Keywords : Aspergilloma, aspergillosis, CPA, Tuberculosis, Ketoconazole.