Abstract Immunosuppressed patients with systemic lupus erythematosus (SLE) are at increased risk of opportunistic pulmonary infections. Aspergillus terreus is a rare pathogen with variable antifungal susceptibility and a propensity for aggressive airway involvement. We report a case of pulmonary aspergillosis associated with severe segmental bronchial stenosis in a patient with active SLE and newly confirmed secondary antiphospholipid syndrome (APS). Case Presentation A 33-year-old woman with a 20-year history of SLE, lupus nephritis, and hypertension presented with 5 days of malaise, diarrhea, weakness, and low-grade fever, without cough or dyspnea. Chronic therapy included mycophenolate mofetil, hydroxychloroquine, and supportive medications. Laboratory testing revealed positive antinuclear antibodies (2× upper limit of normal) and low C4. APS had previously been ruled out; repeat inpatient testing was negative, but lupus anticoagulant became positive at discharge. Chest CT demonstrated pneumonia in the posterior and apical right upper lobe with bilateral multinodular involvement. Bronchoscopy identified Cotton grade III stenosis in the posterior right upper lobe. Bronchoalveolar lavage was positive for A. terreus by PCR.Voriconazole (200 mg q12h) was initiated with clinical improvement. Follow-up CT showed partial resolution of nodules and decreased consolidation. The patient was discharged on prolonged outpatient antifungal therapy with pulmonology and infectious disease follow-up. Conclusion This case highlights an uncommon presentation of pulmonary aspergillosis due to A. terreus, complicated by severe focal airway stenosis in an immunosuppressed SLE patient. Early bronchoscopy, molecular identification, and timely initiation of voriconazole were critical to favorable outcomes. Delayed seroconversion confirming secondary APS reinforces the need for continued immunologic surveillance in high-risk autoimmune populations. This abstract is funded by: none
Milan et al. (Fri,) studied this question.