Chronic Pulmonary Aspergillosis Misdiagnosed as Smear-Negative Pulmonary Tuberculosis in a TB Clinic in Nigeria

The clinical manifestations of chronic pulmonary aspergillosis (CPA) and pulmonary tuberculosis (PTB) are practically indistinguishable. We present a case of CPA in a 35-year-old HIV-negative trader, who had had three unsuccessful treatment courses for smear-negative PTB. He presented with a five-year history of recurrent symptoms suggestive of TB (haemoptysis, weight loss and productive cough). His sputum smear was acid-fast bacilli negative and GeneXpert analysis was negative for Mycobacterium tuberculosis. Chest X-rays revealed bilateral apical cavities and bullae. His Aspergillus-specific IgG tests were positive (>40 mg/L). He was managed with itraconazole 200mg twice daily with marked improvement in his clinical presentation and his quality of life after 4 months of therapy. However, he significantly deteriorated after discontinuing itraconazole for 1 month; he had adherence counselling and was re-commenced on long-term itraconazole therapy.