Successful Treatment of Aspergilloma With Antifungal Alone: A Case of Conservative Management.

Pulmonary aspergilloma can cause life-threatening haemoptysis. Surgical resection and/or bronchial artery embolization (BAE) are established treatment modalities, but both can be risky in frail patients with comorbidities. Spontaneous regression of aspergilloma with antifungal agents alone is rare. We report an elderly gentleman with a background history of treated pulmonary tuberculosis, who presented with haemoptysis due to a large left upper lobe aspergilloma. He declined surgery and BAE due to perceived risks. Oral voriconazole and later isavuconazole were prescribed, which led to clinical improvement and significant reduction in the size of the aspergilloma over 6 months. Antifungal agents might be a viable therapeutic option for aspergilloma patients unsuitable or who declined more invasive procedures. Further studies are needed to validate the efficacy and safety of this approach.