# Post-Lobectomy Pleural Aspergillosis with Bronchopleural Fistula in a Patient with Metastatic Synovial Sarcoma of the Lung: A Case Report

## TL;DR

A 28-year-old man with lung cancer developed a rare fungal infection in the pleura after surgery, requiring combined surgical and antifungal treatment.

## Contribution

This case report highlights the rare occurrence of post-lobectomy pleural aspergillosis with bronchopleural fistula in a patient with metastatic synovial sarcoma.

## Key findings

- The patient developed pleural aspergillosis after thoracic surgeries for metastatic synovial sarcoma.
- Aggressive surgical debridement and antifungal treatment effectively controlled the infection.
- Aspergillus fumigatus was confirmed through in vitro diagnostics from pleural specimens.

## Abstract

In clinical practice, healthcare providers encounter a rising incidence of aspergillosis, which significantly affects morbidity and mortality in vulnerable patients. Over the past few decades, molds have increasingly affected patients with underlying pleuropulmonary, hematological, or oncological diseases undergoing cytotoxic treatment or immunosuppression, leading to impaired cell-mediated immunity and an increased risk of postoperative complications. Although the spectrum of Aspergillus infection is variable, ranging from allergic to chronic, invasive manifestation, pleural involvement is rarely reported. Pleural aspergillosis is an extrapulmonary manifestation of invasive aspergillosis, associated with thoracic surgical procedures and with a bronchopleural fistula, not necessarily combined with pulmonary aspergillosis. An elective or emergency thoracic surgery in immunocompromised patients increases the risk of postoperative infectious complications. Herein, we report a case of isolated postoperative pleural aspergillosis in a 28-year-old immunocompromised man with metastatic synovial sarcoma in the lungs, who underwent pleurodesis for pneumothorax, lobectomy for lung metastasis, and subsequently required decortication and thoracoplasty to achieve effective control of infection. To address this, the patient responded well to aggressive surgical debridement along with both systemic and intrapleural antifungal agent instillation. The essential in vitro diagnostics, including microscopy, microbiological culture and histopathological examination, both from necrotic pleural specimens, detected Aspergillus fumigatus, a global priority species of invasive aspergillosis. Postoperative aspergillosis with pleural involvement and bronchopleural fistula, in immunocompromised patients with sarcoma, is rarely reported, requiring a combination of surgical approach and optimized antifungal treatment regimens. The current knowledge on pleural aspergillosis management remains limited, and highlights the need for case reporting to refine expertise.