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Invasive Pulmonary Aspergillosis — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesInvasive Pulmonary AspergillosisRACP Adult Medicine

A 55-year-old man with AML on induction chemotherapy (neutropenic for 18 days) develops fever unresponsive to broad-spectrum antibiotics. CT chest shows a halo sign (ground-glass opacity surrounding a pulmonary nodule). Serum galactomannan is positive (index 2.5). Bronchoalveolar lavage galactomannan is positive. What is the most likely diagnosis?

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Correct answer: E — Invasive pulmonary aspergillosis

Prolonged neutropenia (>10 days), fever on broad-spectrum antibiotics, halo sign on CT, and positive serum galactomannan (>0.5 index) is invasive pulmonary aspergillosis until proven otherwise. Halo sign (early) and air-crescent sign (late, during neutrophil recovery) are characteristic CT findings. Treatment: voriconazole (first-line) or isavuconazole. Liposomal amphotericin B is second-line.

Reference: eTG Antibiotic – 2025 – Invasive Aspergillosis; IDSA 2024 Aspergillosis