Necrotizing pulmonary aspergillosis caused by anorexic syndrome - a case report

The patient presented is a 44-year-old female treated for cavitary changes in the lung apexes. Due to suspected tuberculosis, treatment began with anti-tuberculosis (AT) drugs, despite negative sputum smears for acid-fast bacilli. During hospitalization, the patient was febrile (up to 38A degrees C), hypotensive, extremely cachectic (32 kg), had a dry cough, increased nitrogen products, hypokalemia and anemia. Because of poor response to the applied AT therapy, bronchoscopic tests were repeated and spores of aspergillus fungus were discovered in the pathohistological findings of transbronchial lung biopsy. The appropriate treatment with amphotericin B and voriconazole was initiated. A psychiatric opinion was requested because we suspected that the patient suffered from the anorexic syndrome (anorexia nervosa). This diagnosis was confirmed by a psychiatrist; her psychiatric treatment began simultaneously with the treatment in our facility. Anorexia was the cause of the cachexia, immunodeficiency and invasive pulmonary aspergillosis. The disorder was not recognized before the manifestation of the somatic disorder. There is little data in the available literature on the association between these two diseases.