Fatal Massive Hemoptysis in a Patient on Low-Dose Oral Prednisone: Chronic Necrotizing Pulmonary Aspergillosis

Abstract

We report a case of chronic necrotizing aspergillosis in a 74-year-old man with chronic lung disease, who was on low-dose oral prednisone. The patient was treated with various antibiotics but had no improvement. Samples obtained via bronchoscopy grew Aspergillus, and the patient was started on lipid formulation amphotericin B. Three days after admission the patient developed fatal massive hemoptysis, presumably secondary to acquired systemic-to-pulmonary vascular communication. This is an unusual presentation of a rare manifestation of pulmonary aspergillosis. A high index of suspicion is needed to diagnose this condition in susceptible patients.