Angioinvasive pulmonary aspergillosis in an immunosuppressed patient causing vasculitis and bronchiolitis obliterant: case report and literature review with emphasis on Bolivia

Abstract

Introduction: Angioinvasive pulmonary aspergillosis is a severe fungal infection that may clinically and histologically mimic ANCA-associated vasculitis, particularly in patients with autoimmune diseases or under immunosuppressive therapy. Reports from Bolivia remain rare. Clinical Case: A 39-year-old female patient with rheumatoid arthritis and Sjögren's syndrome, immunosuppressed with corticosteroids, developed pulmonary aspergillosis during antifungal treatment. She experienced an exacerbation of her pulmonary condition, with severe dyspnea and progressive atelectasis of the left lung with bronchial stenosis confirmed by bronchoscopy. She required prolonged ventilatory support, which did not respond to treatment, and a left functional pneumonectomy was performed. Histopathological analysis confirmed invasive pulmonary aspergillosis (IPA) with microvascular involvement (secondary vasculitis) and concomitant bronchiolitis obliterans, demonstrating irreversible damage that made lung preservation unfeasible. Review: Literature on angioinvasive aspergillosis mimicking vasculitis was reviewed, highlighting the diagnostic and therapeutic relevance of thoracic surgery. Conclusion: This case highlights the importance of considering angioinvasive aspergillosis in autoimmune patients with severe pulmonary compromise. Radical surgical management can be both diagnostic and therapeutic in cases of bronchial obstruction or diffuse pulmonary destruction.