Echinococcal Cyst? No! Chronic Cavitary Pulmonary AspergillOSIs!

The good Dr. Burnett presented a case of a middle-aged woman with asthma and extensive travel history who presented with acute onset dyspnea and cough, found to have significant peripheral eosinophilia and cavitary lung lesion, treated with lobectomy for presumed ruptured echinococcal cyst, but ultimately found to have aspergillus!

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Take Home Points:

  1. The interns & residents in the room crushed the differential for peripheral eosinophilia, which includes allergic, infectious, neoplastic, and immunologic etiologies. See this article for more details and approaches to work-up! This case highlighted an instance of eosinophilia secondary to fungal infection, which was initially misdiagnosed in part due to the classic association with parasitic infections.
  2. Big thanks to Dr. Burnett for this excellent article – a good review from Chest about diagnosis and treatment of pulmonary aspergillosis syndromes.
  3. IDSA guidelines recommend voriconazole as first line therapy for invasive pulmonary aspergillosis, while itraconazole is first line for allergic bronchopulmonary aspergillosis (ABPA). For chronic cavitary pulmonary aspergillosis, either voriconazole or itraconazole may be used first line.