209 Sterile Hyphae from an Immunocompromised Patient with Chronic Pulmonary Aspergillosis

Introduction/Objective Chronic Pulmonary Aspergillosis (CPA) is a destructive, low prevalence, pulmonary disease caused by Aspergillus spp. It is often misdiagnosed in patients with comorbid conditions. Our case underscores the challenges in diagnosing and treating chronic aspergillosis in immunocompromised patients with complex underlying conditions. Methods/Case Report A 53-year-old woman presented with cough and hemoptysis. She was treated with immunosuppressive agents for CREST syndrome and had a history of lobectomy for fibrocavitary lung disease due to Mycobacterium avium complex. While radiological studies suggested CPA with mycetoma suspicious for Aspergillosis spp. infection, repeated pulmonary cultures between 2019 and 2024 yielded only hyaline mycellia without conidiation that could not be morphologically identified to genus/species. Aspergillus galactomannan antigen remained low (0.08). In June 2024, mold cultures were further evaluated using MALDI-TOF mass spectrometry and genotyping. Both studies identified Aspergillus fumigatus. Results NA Conclusion Mycologists should recognize mycology cultures from chronically infected patients that repeatedly produce sterile hyphae. Mold identification by MALDI-TOF or genotyping should be considered in such instances. Galactomannan is often positive in invasive aspergillosis but has limited utility in the diagnosis of CPA as this case demonstrates. MALDI-TOF can assist in the accurate and rapid mold identification to establish diagnoses and guide effective antifungal therapy in challenging clinical scenarios.