Case report
An Unusual Case of Aspergillus Fibrosing Mediastinitis

https://doi.org/10.1016/j.athoracsur.2009.02.087Get rights and content

Fibrosing mediastinitis due to Aspergillus is rare, particularly in the immunocompetent host. Fibrosing mediastinitis due to Aspergillus species in the immunocompetent patient can be indolent and may be treated with antifungal therapy rather than surgery. We present a 78-year-old nonsmoking, nondiabetic woman with chronic fibrosing mediastinitis due to Aspergillus. Multiple attempts at securing a tissue diagnosis were inconclusive. Ultimately, Aspergillus infection was diagnosed by a video-assisted thoracoscopic surgical biopsy. The patient was started on oral voriconazole, and she remains clinically stable with radiographic improvement. A prolonged, perhaps lifelong, course of antifungal therapy is planned.

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Comment

Aspergillus, a mold found throughout the environment, may cause invasive disease in the immunocompromised host, but it is a rare pathogen in the immunocompetent individual [1, 2, 3]. The most common manifestation of invasive aspergillosis is pneumonia, because the lungs serve as the main portal of entry for inhaled spores [4]. Although there are many causes of fibrosing mediastinitis, most cases are usually due to the immunologic reaction to the antigens of Histoplasma, also found throughout

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