AUTHOR=Guziejko Katarzyna , Klukowska Katarzyna , Budzińska Urszula , Mróz Robert Marek 

TITLE=Case Report: Chronic Pulmonary Aspergillosis—An Unusual Long-Term Complication of Lung Cancer Treatment

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.777457

DOI=10.3389/fmed.2021.777457

ISSN=2296-858X

ABSTRACT=Background
Chronic pulmonary aspergillosis (CPA) is rare complication of radiochemotherapy for lung cancer. It may develop months or years after radical treatment. Diagnosis of CPA is challenging and complex. Not only the fungal infection but also cancer relapse always have to be taken under consideration. Antifungal therapy is the base treatment, especially in case when surgical procedure is not possible. Standard treatment for at least 6 months is recommended but optimal duration of the antifungal therapy in unknown. We present the clinical case of CPA, in which we had to performed multidirectional diagnostic tests to confirm the diagnosis and modified treatment due to recurrence of the disease.
Case presentation
We report a patient who developed CPA three and a half years after concurrent radiochemotherapy for locally advanced non-small-cell lung cancer. Nonspecific symptoms were the cause of delayed diagnosis of fungal infection. Samples collected during bronchoscopy allowed to exclude the recurrence of lung cancer and establish diagnosis of CPA. The patient was treated with itraconazole for 6 months. Few months later controlled chest computed tomography scans revealed progression of CPA. Initially retreatment with itraconazole was implemented. Due to progression of fungal infection voriconazole was used in the second line of treatment. Unfortunately, this therapy was complicated by the side effects and deterioration of the patient's condition. The reintroduction of itraconazole resulted in clinical and radiological improvement. Treatment is scheduled for at least 12 months. 
Conclusions
CPA was the cause of clinical deterioration and radiological progression in a patient after radical treatment of lung cancer. In the described case, the diagnosis of CPA was delayed because of the suspicion of recurrence of lung cancer. As the surgery was not possible, antifungal therapy with itraconazole was implemented and the proper dosage and duration led to significant clinical improvement.