Aspergillus mediastinal lymphadenopathy with bronchial invasion mimicking cancer in an immunocompetent host

Abstract

The clinical presentation of pulmonary mycotic disease is determined by the interaction between the fungus and host. Inhalation of spores resulting in sino-pulmonary disease is the most frequent manifestation. It can have a myriad radiological manifestations ranging from ground glassing, fleeting consolidations, and cavitation to interstitial thickening. Mediastinal lymphadenopathy locally eroding into multiple bronchi is highly unusual. The main clinical presentations are cough, hemoptysis, and dull chest pain. Diagnosis is based on either indirect serological tests or direct visualization of hyphae under the microscope. We present a case of a 25-year-old laborer with hemoptysis and weight loss; found to have mediastinal lymphadenopathy invading endobronchially. Tuberculosis, lymphoma, and bronchogenic carcinoma were our initial differential diagnosis, but invasive aspergillosis was later confirmed following biopsy. The role of a fungal etiology in pulmonary lesions among immunocompetent individuals is often overlooked. This case highlights the need to keep a broad differential in mind while dealing with mediastinal lymphadenopathy.