Differential diagnosis of infections in a patient with Chronic Obstructive Pulmonary Disease

Abstract

We describe a case of a 65-years-old patient with Chronic Obstructive Pulmonary Disease (COPD), receiving oxygen therapy and resistant to antibiotic therapy. He was admitted with high fever, productive cough, marked leukocytosis, and chest X-ray findings of infiltration and fluid levels within lung cysts. A differential diagnosis was essential to start an adequate treatment and avoid the rapid worsening of patients respiratory status. In patients with chronic pulmonary diseases under immunotherapy, micotic infections should be considered. Aspergillus fumigatus was cultured from bronchial washing fluid and we diagnosed chronic necrotizing pulmonary aspergillosis (CNPA). Oral itraconazole was started and his symptoms and laboratory data markedly improved.