44-year-old male, quarry worker for 26 years. History of smoking and alcoholism. Diagnosed with pulmonary tuberculosis in 2008 and treated for 12 months. He was readmitted one year later due to haemoptysis and general syndrome of 2 months' evolution. Physical examination revealed a low-grade fever (37.3oC), with rhonchi and bilateral crackles on pulmonary auscultation. Blood tests showed leukocytosis (17,000 cells/μl with 77% neutrophils, alkaline phosphatase of 395 μ/l and ESR of 15 mm/h. Chest X-ray showed a diffuse bilateral micronodular interstitial pattern and a conglomerate in LSD and thick-walled cavitary lesion in LSI, similar to previous studies. Chest CT showed extensive bilateral micronodular interstitial involvement with multiple calcified adenopathies, a large conglomerate in LSD with calcifications inside similar to previous studies, and an increase in the lesion of the left upper lobe (LSI) with new cavitation, with floating material inside compatible with aspergilloma. Sputum smears were negative and sputum culture was positive for Aspergillus flavus. Serology was also positive for Aspergillus flavus and the galactomannan antigen was weakly positive. Treatment with itraconazole was started. She returned 3 months later for haemoptysis with persistent positive cultures for Aspergillus and treatment was changed to voriconazole with good clinical evolution until the present time (3 months of treatment).
