Snapshot A 7-year-old male with a past medical history of chronic granulomatous disease presents with hemoptysis. Chest radiograph and CT scan showed bilateral infiltrates and consolidation of the right upper lobe. Broncho-alveolar lavage was carried out and culture revealed fungi with septate hyphae branching at acute angles. (Invasive aspergillosis) A 40-year-old male presents with a two month history of fever, cough, and night sweats. He had been treated adequately for pulmonary tuberculosis about a year ago. He is AAFB negative. Chest radiograph reveals a cavitary lesion in the left upper lobe. CT scan further showed a mobile mass within the cavity with a cresentic rim. Fine needle aspiration cytology revealed fungal hyphae and inflammatory cells. (Aspergilloma) A 50-year-old male presents with a five day history of productive cough with brownish plugs of sputum. Two days ago he developed chest pain. He denies cough, fever, and shortness of breath. He is a known asthmatic on inhaled bronchodilators and corticosteroids. Chest radiograph revealed irregular consolidation of the right upper and midddle lobes. Serum IgE was 6622 IU/ml, serum eosinophils was 1100 cells/mm3 and allergen-specific IgE for Apergillus fumigatus was 4+. (Allergic bronchopulmonary aspergillosis) Introduction Diseases inhalation of ubiquitous Apergillus spores causes 3 diseases allergic bronchopulmonary aspergillosis asthma-like allergic reaction in airways proximal bronchiectasis type I and type IV hypersensitivity reactions mucus plugs form but do not penetrate tissue aspergilloma seen in TB patients (or other granulomatous disease) "fungus ball" forms in pre-existing lung cavities invasive aspergillosis invasive infection of the lung usually in immunocompromised pleuritic pain and hemoptysis infiltrate seen on radiograph and CT Toxins Aspergillus spp. produces aflatoxin causes liver damage and liver cancer aflatoxin B1 causes G:C → T:A mutation in codon 249 of p53 increased risk of hepatocellular carcinoma Evaluation Laboratory monomorphic septate hyphae branch at acute angles "ASpergillus is Acute and Septate" fruiting bodies are rare a recycler (found in compost piles) catalase-positive Differential Invasive aspergillosis mucormycosis Allergic bronchopulmonary aspergillosis differential diagnosis of pulmonary eosinophilia Aspergilloma differential diagnosis of a pulmonary nodule/mass Treatment Allergic bronchopulmonary aspergillosis systemic corticosteroids and oral itraconazole Aspergilloma surgery Invasive aspergillosis voriconazole, amphotericin B, or caspofungin Prognosis, Prevention, and Complications Prognosis poorest with invasive aspergillosis seen in immunocompromised patients neutropenia and glucocorticoid use predispose to infection