Long-term suppressive therapy for pulmonary aspergilloma in an immunocompromised man with AIDS. Is it always necessary?

Aspergillus infections are rare opportunistic infections in the course of AIDS and they mostly present as invasive pulmonary disease. Owing to the prolonged survival of profoundly immunocompromised patients with AIDS, invasive pulmonary aspergillosis is being reported with increased frequency. However, although pulmonary aspergilloma has been well described in immunocompetent patients, it has been rarely reported in AIDS patients. The treatment for pulmonary aspergilloma remains challenging and often needs lifelong treatment to minimize fatal haemoptysis, which can occur in up to 25%, and progression to secondary invasive aspergillosis. We report a case of pulmonary aspergilloma in a severely immunocompromised patient with AIDS who stopped taking systemic antifungal treatment in April 1998 and remained well with little progression of invasive aspergillosis up until March 2002 when he died of acute pancreatitis related to a drug interaction of didanosine and tenofovir.