A 44-year-old man worked in quarries for 26 years.
History of smoking and drinking
She was diagnosed with pulmonary tuberculosis in 2008 and treated for 12 months.
He was readmitted one year later for hemoptysis and general syndrome of 2 months of evolution.
On physical examination, the patient had a high fever (37.3oC), with roncus and bilateral crackles on auscultation.
The laboratory tests showed leukocytosis (17,000 cells/μl with 77% neutrophils, alkaline phosphatase 395 μl and SGA 15 mm/h.
The chest X-ray showed a diffuse bilateral micronodular interstitial pattern and a cluster in LSD and a thick wall cavitary lesion in LSI, similar to previous studies.
Chest CT showed extensive bilateral interstitial micronodular involvement with multiple calcified adenopathies, a large cluster in LSD with calcifications in its interior similar to previous studies, showing a cavitating lesion in the upper lobe with a new fluid.
Sputum smears were negative and sputum culture was positive for Aspergillus flasks.
Serology was also positive for Aspergillus flaxseeds and antigenmanano presented weak positivity.
Treatment with itraconazole was started.
He came back 3 months later for hemoptysis with persistent culture positive for Aspergillus, and the treatment was changed to voriconazole with good clinical evolution up to now (3 months of treatment).
