Abstract Introduction Organizing pneumonia (OP) is a nonspecific pattern of lung injury that often responds to corticosteroids, which themselves can predispose to fungal infection. Aspergillus species are recognized triggers of secondary OP, representing a reparative response to infection-related injury. We describe a case of subacute invasive pulmonary aspergillosis (IPA) caused by Aspergillus niger occurring alongside biopsy-proven OP, illustrating coexisting infectious and reparative processes in a cirrhotic host. Case Description A 45-year-old woman with cirrhosis was admitted for persistent productive cough, dyspnea, and pleuritic chest pain following recent bacterial pneumonia treatment. Vital signs and laboratory studies were unremarkable. Chest CT demonstrated cavitary lesions containing internal hypodensities, patchy consolidations, and a moderate pleural effusion (Figure). Initial infectious and autoimmune workups were negative. Broad-spectrum antibiotics were started. Bronchoscopy revealed purulent right-sided secretions. BAL from the right upper lobe grew Aspergillus, which was initially considered a colonizer, so only antibacterial therapy was continued. As her condition worsened with hypoxemia requiring intubation and chest tube insertion, empiric antifungal therapy with amphotericin B and voriconazole was started. Results from transbronchial biopsies of the right lower lobe subsequently revealed fibromyxoid plugs consistent with OP, with negative GMS, PAS, and AFB stains, prompting corticosteroid initiation. Final culture and PCR results confirmed Aspergillus niger from sputum, BAL, and lung tissue, establishing subacute IPA rather than colonization. The patient gradually improved on combined antifungal and corticosteroid therapy and was transitioned to voriconazole, micafungin, and a prednisone taper with atovaquone prophylaxis. Follow-up CT two months later showed marked improvement of consolidations and effusion. Discussion This case illustrates subacute IPA caused by Aspergillus niger, complicated by OP in a cirrhotic host. Reports describing this association are limited, and to our knowledge, this is the first involving underlying liver disease—a condition increasingly recognized as a risk factor for IPA. The case underscores the diagnostic limitations of BAL alone; without tissue biopsy, coexisting OP would have been missed and corticosteroids withheld. Awareness of this dual pathology may facilitate earlier diagnosis and optimized management. This abstract is funded by: None
Pitaktong et al. (Fri,) studied this question.
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