CRA6 COEXISTING ASPERGILLOSIS AND LUNG ADENOCARCINOMA IN AN ASYMPTOMATIC PATIENT WITH MYASTHENIA GRAVIS

FY Chew1, NC Huan1, AR Muhamad Yusuf 2
1Department of Respiratory, Hospital Queen Elizabeth
2Department of Pathology, Hospital Queen Elizabeth
 

Introduction

Inhalation of Aspergillus spores can cause a wide spectrum of respiratory diseases, ranging from hypersensitivty reactions to profound angioinvasion. Coexisting aspergilloma with lung adenocarcinoma is rare. We describe an asymptomatic elderly lady with concurrent aspergillosis and lung adenocarcinoma which was diagnosed incidentally durying work-up for myasthenia gravis.

Results

A 70 yr old lady, non- smoker, with underlying myasthenia gravis and thymoma, was referred for an incidental finding of a left upper lobe cavitating lesion. She was asymptomatic. Clinical examination was unremarkable. Flexible bronchoscopy revealed normal airway segments; bronchial washing results for mycobacterial, fungal and bacterial cutlures were negative. Bronchial washing sent for cytology showed cellular atypia, raising suspicion of lung malignancy. A Computed tomography (CT) guided lung biopsy was eventually performed which revealed the presence of both lung adenocarcinoma and fungal bodies that were consistent with aspergillosis. Her CT and positron-emission tomography (PET) scan showed no evidence of mediastinal and distant metastases. Her case was subsequently discussed in a lung cancer multidisciplinary team meeting whereby a recommendation was made for resection of both her thymoma and lung lesion.

Discussion and Conclusion

Aspergillus lung infection can rarely occur in the setting of lung cancer. Possible postulates in this case include rapid lung cancer cell growth leading to cellular death and necrosis which provide a favourable thriving environment for Aspergillus as well as impaired patient immune status from long-term azathioprine use for myasthenia gravis. Surgical resection can be a curative treatment for early-stage lung cancers. Therefore, prompt diagnosis and early treatment are essential to ensure a good clinical outcome.