Question

A 29-year old patient presents with a 9-month history of recurrent hemoptysis. The patient suffered from cavitary tuberculous infection 5 years ago and was effectively treated with antituberculous drugs. A thin-walled cavity was seen over the right upper lobe when first diagnosed. At a later date, a progressive opacification of tuberculous cavity was seen. What organism is most likely responsible for such radiologic changes of a tuberculous cavity?

1. Secondary growth of staphylococci
2. Growth of Candida albicans might have filled the cavity
3. Growth of Aspergillus fumigatus might have filled the cavity
4. The cavity filled with granulation tissue and subsequent fibrosis
5. The cavity filled with desquamated epithelial cells of alveoli

Answer 1

The most likely organism responsible for the filling of a previously noted tuberculous cavity with progressive opacification on radiologic imaging is Aspergillus fumigatus, known to cause aspergilloma within pre-existing lung cavities. The correct option is 3.

Step-by-step explanation:

The patient's previous history of a cavitary tuberculous infection and subsequent radiologic changes suggesting a filled cavity leads to a suspicion of a secondary infection within the tuberculous cavity. Given the specific clinical context and the radiological findings, the organism that is most likely responsible for such changes is Aspergillus fumigatus.

This is a common scenario referred to as a fungal ball or aspergilloma that can develop in the pre-existing cavities in the lung, such as those resulting from tuberculosis (TB). Aspergillus fumigatus is a fungus that can colonize and grow within these cavities, leading to progressive opacification as seen in imaging studies.

This outcome is consistent with the description of the progressive opacification of a tuberculous cavity as mentioned in the patient's history.