ABSTRACT

Opportunistic fungal infection by Aspergillus oryzae in patients with chronic respiratory condition is rare in India. A 52-year-old male with a history of diabetes mellitus, chronic smoking, and alcoholism presented with chronic cough, breathlessness, and recurrent blood in sputum. CT imaging revealed features consistent with old pulmonary tuberculosis sequelae and the presence of a right lung lower lobe aspergilloma. The patient underwent a right lower lobectomy, and histopathological examination confirmed severe acute and chronic bronchiolitis with bronchiectasis and organizing pneumonia, indicative of fungal ball formation. Microbiological analysis identified Aspergillus species, possibly A. flavus complex, with sequencing confirming A. oryzae. This case is unique as A. oryzae is typically associated with food fermentation and rarely implicated in invasive lung infections, especially outside regions of traditional exposure, like Japan. The rarity of this presentation underscores the importance of considering unusual pathogens in clinical practice and utilizing advanced diagnostic techniques such as sequencing for accurate identification. The successful outcome of this case, with prolonged antifungal therapy based on microbiological confirmation and clinical follow-up, suggests the importance of personalized treatment strategies. This case report adds to the growing body of evidence on the clinical significance and pathogenic potential of A. oryzae. It underscores the importance of continued vigilance and research in fungal infections.