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Chronic pulmonary aspergillosis — SCE Respiratory MCQ

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HardRespiratory InfectionsChronic pulmonary aspergillosisSCE Respiratory

A 67-year-old man with COPD and a previous apical cavity after tuberculosis has 4 months of weight loss, cough and intermittent haemoptysis. CT shows a thick-walled cavity with pleural thickening but no new consolidation. Aspergillus IgG is strongly positive and sputum grows Aspergillus fumigatus. What is the most likely diagnosis?

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Correct answer: C — Chronic pulmonary aspergillosis

A chronic cavitary syndrome with weight loss, haemoptysis, pleural thickening and positive Aspergillus IgG after prior TB is typical of chronic pulmonary aspergillosis. ABPA is an asthma/bronchiectasis allergic syndrome with high IgE, while invasive aspergillosis occurs mainly in profound immunosuppression. Bacterial abscess and TB remain differentials, but the chronic cavity plus Aspergillus IgG makes CPA best.

Reference: ERS/ESCMID Aspergillus guidance; BTS TB/NTM resources