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Morphological analysis of bronchoalveolar lavage fluid in diagnosing pulmonary aspergilloma in a patient with rheumatoid arthritis: A case report

  • Authors:
    • Yuli Zhou
    • Yuyi Lai
    • Fuxian Zhou
    • Xinxin Wang
    • Xiao He
    • Juan Jin
    • Ruikai Zhang
  • View Affiliations / Copyright

    Affiliations: Department of Laboratory Medicine, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China, Department of Laboratory Medicine, The First People's Hospital of Nanning, Nanning, Guangxi Zhuang Autonomous Region 530016, P.R. China, Department of Laboratory Medicine, Yanbian University Hospital, Yanji, Jiling 133000, P.R. China, Department of Laboratory Medicine, The First People's Hospital of Jinzhong, Jinzhong, Shanxi 030699, P.R. China, Department of Radiology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China, Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang 310000, P.R. China
    Copyright: © Zhou et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 191
    |
    Published online on: May 14, 2026
       https://doi.org/10.3892/etm.2026.13186
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Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder that primarily affects the joints and may be associated with systemic complications. Patients with RA have an increased susceptibility to opportunistic infections, attributable to inherent immune dysregulation as well as immunosuppressive therapies, including tocilizumab, particularly among those with comorbidities or high disease activity. Notably, the use of tumor necrosis factor inhibitors, such as adalimumab and etanercept, has been associated with a higher incidence of invasive pulmonary aspergillosis and chronic pulmonary aspergillosis. The present study reports a rare case of pulmonary aspergilloma in a 75‑year‑old female RA patient with prior tuberculosis and long‑term tocilizumab use. The patient was diagnosed via bronchoalveolar lavage fluid morphology, fungal culture, Aspergillus galactomannan assay, metagenomic next‑generation sequencing and pathology, and the patient achieved symptom resolution and improved imaging after 6 months of treatment with voriconazole. These findings underscore the need for vigilant monitoring and individualized management strategies in this patient population. 
View Figures

Figure 1

Imaging findings. (A) Calcified lymph
nodes (indicated by arrows); (B) air crescent sign (crescent-shaped
low-density area within a high-density nodule, indicated by arrow);
(C) left pleural effusion (arcuate fluid density shadow, indicated
by arrow); (D) left lung inflammatory lesion (patchy high-density
shadow with ill-defined border, indicated by arrow). CT parameters:
120 kV, 80 mAs, 1-mm slice thickness, lung window (WL: -600 HU, WW:
1,500 HU), mediastinal window (WL: 40 HU, WW: 400 HU). CT, computed
tomography; WL.

Figure 2

Morphology of pulmonary
Aspergillus fumigatus aspergilloma. (A) BALF, wet film
unstained (magnification, x400), a large number of fungi can be
seen in dense clusters, and the mycelium can be seen at the edge of
each other and disorderly arrangement. (B) BALF, Wright-Giemsa
stain (magnification x1,000), small segments of mycelia-like
bamboo, dyed light blue, and mycelia division is clear. (C) BALF,
Reichsen-Giemsa staining (magnification x1,000), numerous mycelial
interleaved fungal clusters. (D) BALF, Gram staining
(magnification, x1,000), mycelium staining is light, and obviously
visible. (E) BALF, fungal fluorescence staining (magnification,
x400), showing a large number of fungal mycelia. (F) BALF cell
block (magnification, x400), clumps of Aspergillus hyphae.
(G) A biopsy of the anterior segment of the upper lobe of the lung,
broken mucosal tissues (magnification, x100), extensive
infiltration of lymphocytes, plasma cells and neutrophils in the
mucosal interstitium (black arrow): Also see Aspergillus
cluster (red arrow). It can be seen that Aspergillus cluster
and lung tissue separation, in line with the formation of
aspergilloma structure characteristics. (H) Lavage culture, colony
after 3 days of Columbia blood plate culture, arrow point. (I)
A. fumigatus after 3 days of lavage culture, phenol cotton
blue staining (magnification, x1,000). BALF, bronchoalveolar lavage
fluid.
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Copy and paste a formatted citation
Spandidos Publications style
Zhou Y, Lai Y, Zhou F, Wang X, He X, Jin J and Zhang R: Morphological analysis of bronchoalveolar lavage fluid in diagnosing pulmonary aspergilloma in a patient with rheumatoid arthritis: A case report. Exp Ther Med 32: 191, 2026.
APA
Zhou, Y., Lai, Y., Zhou, F., Wang, X., He, X., Jin, J., & Zhang, R. (2026). Morphological analysis of bronchoalveolar lavage fluid in diagnosing pulmonary aspergilloma in a patient with rheumatoid arthritis: A case report. Experimental and Therapeutic Medicine, 32, 191. https://doi.org/10.3892/etm.2026.13186
MLA
Zhou, Y., Lai, Y., Zhou, F., Wang, X., He, X., Jin, J., Zhang, R."Morphological analysis of bronchoalveolar lavage fluid in diagnosing pulmonary aspergilloma in a patient with rheumatoid arthritis: A case report". Experimental and Therapeutic Medicine 32.1 (2026): 191.
Chicago
Zhou, Y., Lai, Y., Zhou, F., Wang, X., He, X., Jin, J., Zhang, R."Morphological analysis of bronchoalveolar lavage fluid in diagnosing pulmonary aspergilloma in a patient with rheumatoid arthritis: A case report". Experimental and Therapeutic Medicine 32, no. 1 (2026): 191. https://doi.org/10.3892/etm.2026.13186
Copy and paste a formatted citation
x
Spandidos Publications style
Zhou Y, Lai Y, Zhou F, Wang X, He X, Jin J and Zhang R: Morphological analysis of bronchoalveolar lavage fluid in diagnosing pulmonary aspergilloma in a patient with rheumatoid arthritis: A case report. Exp Ther Med 32: 191, 2026.
APA
Zhou, Y., Lai, Y., Zhou, F., Wang, X., He, X., Jin, J., & Zhang, R. (2026). Morphological analysis of bronchoalveolar lavage fluid in diagnosing pulmonary aspergilloma in a patient with rheumatoid arthritis: A case report. Experimental and Therapeutic Medicine, 32, 191. https://doi.org/10.3892/etm.2026.13186
MLA
Zhou, Y., Lai, Y., Zhou, F., Wang, X., He, X., Jin, J., Zhang, R."Morphological analysis of bronchoalveolar lavage fluid in diagnosing pulmonary aspergilloma in a patient with rheumatoid arthritis: A case report". Experimental and Therapeutic Medicine 32.1 (2026): 191.
Chicago
Zhou, Y., Lai, Y., Zhou, F., Wang, X., He, X., Jin, J., Zhang, R."Morphological analysis of bronchoalveolar lavage fluid in diagnosing pulmonary aspergilloma in a patient with rheumatoid arthritis: A case report". Experimental and Therapeutic Medicine 32, no. 1 (2026): 191. https://doi.org/10.3892/etm.2026.13186
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