Hemoptysis recurrence in an Indonesian female with pulmonary aspergilloma: A case report

Introduction: and Importance: Pulmonary aspergilloma causes hemoptysis recurrence, and most patients die if surgery is not performed. In this case, the diagnosis challenge was when the patient had a history of pulmonary tuberculosis.Case presentation: An Indonesian female, 25 years old, complained of recurring hemoptysis and dyspnea with a pulmonary tuberculosis history five years ago. First, hemoptysis occurred 2 years ago, treated and cured. Chest X-ray and CT-scan results showed pulmonary tuberculosis, but Mycobacterium tuberculosis was not detected when Ziehl Neelsen and GeneXpert tests were conducted. A repeated CT scan found a fungus ball and was used for differential diagnosis of pulmonary aspergilloma. The patient underwent a left lateral lobectomy and was given 150 mg/day of fluconazole. The patient showed a good prognosis for 2 months and increased body weight by 3 kg.Clinical discussion: The challenge in pulmonary aspergilloma is an atypical sign and symptom that raises suspicion of pulmonary tuberculosis because the patient had a tuberculosis history. Resection in pulmonary aspergilloma is recommended to decrease mortality risk and continue with antifungal drugs to support a good prognosis.Conclusion: Surgery and antifungal management in pulmonary aspergilloma can reduce mortality.