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and a diagnosis of pulmonary tuberculosis 6 months before&#44; still under treatment&#44; with a cavitary lesion in the lingular division&#46; When diagnostic video-bronchoscopy was perfomed&#44; we found a large yellowish hard mass &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; with almost complete obstruction of the lower segment of the lingular division of the LUL&#44; and <span class="elsevierStyleItalic">Aspergillus</span> was confirmed by histological examination&#58; small plugs constituted by fungal structures of <span class="elsevierStyleItalic">Aspergillus</span> species after dyeing with PAS and Grocott &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; At the time of diagnosis&#44; the patient&#44; who was immunocompromised&#44; was on treatment for PT&#44; and began treatment with voriconazole&#44; but he died a few months later&#44; from congestive heart failure&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The endobronchial aspergilloma is a rare entity and was first described by Denning et al&#46; in three patients with AIDS&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> and is usually incidentally detected as a necrotic mass causing bronchial obstruction&#46; It is easily diagnosed by histopathologic examination of the endoscopic biopsies&#44; and should be considered in the differential diagnosis of an endobronchial necrotic lesion&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> in some cases mimicking endobronchial lung cancer&#46; In other cases&#44; superimposed aspergillosis can mask a lung cancer or an endobronchial carcinoid<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> and it can be hard to differentiate true EBA with colonization of <span class="elsevierStyleItalic">Aspergillus</span> of an underlying cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> There are also descriptions of endobronchial aspergilloma associated with a foreign body<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> or causing a bronchomediastinal fistula&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> An EBA can occur in immunocompetent patients&#44; with or without underlying lung disease&#44; and because the optimal treatment or duration of therapy has not yet been established&#44; the EBA requires close medical watch&#46; In our case we describe two forms of aspergilloma in the same patient&#44; an EBA and a pulmonary aspergilloma&#44; and in the course of a treatment for PT&#46; This case is more than just a bronchoscopic curiosity&#44; as it helps us to understand the wide variety of pulmonary aspergillosis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Letter to the Editor
Endobronchial aspergilloma: An unusual presentation of pulmonary aspergillosis
D. Araújoa,
Corresponding author
duartearaujodr@sapo.pt

Corresponding author.
, M. Figueiredoa, P. Monteirob
a Respiratory Department, CHAA, Guimarães, Portugal
b Anatomy Department, CHAA, Guimarães, Portugal
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and a diagnosis of pulmonary tuberculosis 6 months before&#44; still under treatment&#44; with a cavitary lesion in the lingular division&#46; When diagnostic video-bronchoscopy was perfomed&#44; we found a large yellowish hard mass &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; with almost complete obstruction of the lower segment of the lingular division of the LUL&#44; and <span class="elsevierStyleItalic">Aspergillus</span> was confirmed by histological examination&#58; small plugs constituted by fungal structures of <span class="elsevierStyleItalic">Aspergillus</span> species after dyeing with PAS and Grocott &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; At the time of diagnosis&#44; the patient&#44; who was immunocompromised&#44; was on treatment for PT&#44; and began treatment with voriconazole&#44; but he died a few months later&#44; from congestive heart failure&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The endobronchial aspergilloma is a rare entity and was first described by Denning et al&#46; in three patients with AIDS&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> and is usually incidentally detected as a necrotic mass causing bronchial obstruction&#46; It is easily diagnosed by histopathologic examination of the endoscopic biopsies&#44; and should be considered in the differential diagnosis of an endobronchial necrotic lesion&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> in some cases mimicking endobronchial lung cancer&#46; In other cases&#44; superimposed aspergillosis can mask a lung cancer or an endobronchial carcinoid<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> and it can be hard to differentiate true EBA with colonization of <span class="elsevierStyleItalic">Aspergillus</span> of an underlying cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> There are also descriptions of endobronchial aspergilloma associated with a foreign body<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> or causing a bronchomediastinal fistula&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> An EBA can occur in immunocompetent patients&#44; with or without underlying lung disease&#44; and because the optimal treatment or duration of therapy has not yet been established&#44; the EBA requires close medical watch&#46; In our case we describe two forms of aspergilloma in the same patient&#44; an EBA and a pulmonary aspergilloma&#44; and in the course of a treatment for PT&#46; This case is more than just a bronchoscopic curiosity&#44; as it helps us to understand the wide variety of pulmonary aspergillosis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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