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Post-TB Aspergilloma — SCE Infectious Diseases MCQ

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EasyTuberculosisPost-TB AspergillomaSCE Infectious Diseases

A 55-year-old man with treated pulmonary TB (completed 6 months RHZE/RH) presents 2 years later with haemoptysis. CXR shows a mycetoma (fungal ball) within a residual TB cavity in the right upper lobe. Aspergillus IgG is strongly positive. He is not immunocompromised. What is the relationship between TB and aspergilloma?

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Correct answer: A — Post-TB cavities provide a structural niche for Aspergillus colonisation — aspergilloma is a recognised late complication of cavitary TB

Aspergilloma (fungal ball) developing within a pre-existing TB cavity is a well-recognised late complication of cavitary pulmonary TB. The residual cavity provides an ideal environment for Aspergillus colonisation (moisture, oxygen, impaired local immunity). It can develop months to years after TB cure. Most aspergillomas are asymptomatic but can cause life-threatening haemoptysis. Management ranges from conservative (mild symptoms) to bronchial artery embolisation (acute haemoptysis) to surgical resection (recurrent/severe haemoptysis in fit patients). Antifungals have limited efficacy for simple aspergilloma.

Reference: BTS 2017 – CPA/aspergilloma; NICE NG33 2016 – TB; WHO 2022