Clinical and Radiological Response to Antifungal Treatment in Aspergilloma

Abstract

Introduction Aspergilloma can be found in all forms of chronic aspergillosis except for Aspergillus nodules. Whether antifungal treatment or surgery should be the first option remains unclear. Our study retrospectively evaluated patients diagnosed with aspergilloma to investigate their clinical and radiologic responses to antifungal treatment. Materials and Methods We evaluated the demographic, radiological, laboratory, and clinical data; comorbidities; treatment processes (including duration and complications); and clinical and radiological responses after voriconazole treatment in 12 patients diagnosed with aspergilloma between January 2021 and May 2024. Results Radiological response to antifungal treatment was 22.2%, whereas clinical response was 66.7%. Patients with a history of ankylosing spondylitis (AS), previous tuberculosis (TB), destructed parenchyma, bronchiectasis, and old cavities on computed tomography (CT) had a higher, though not statistically significant, clinical response rate to antifungal treatment. The presence of pleural effusion and short treatment duration were associated with a decreased clinical response to treatment (P = 0.018, P = 0.025). Conclusion In aspergilloma, antifungal therapy may be considered primarily for patients with AS, a history of TB, destructed parenchyma on CT, bronchiectasis, previous cavities, and no pleural effusion. Optimal adherence to the treatment duration will improve the clinical response.