Diagnostic Mimicry: Invasive Aspergillosis Masquerading as Pulmonary Tuberculosis in a Patient with Chronic Granulomatous Disease

Zakertavalaee, Fatemeh; Aelami, Mohammad Hassan; Badiee, Parisa; Riyazi, Hedieh

doi:10.22038/jpp.2026.96488.5681

Diagnostic Mimicry: Invasive Aspergillosis Masquerading as Pulmonary Tuberculosis in a Patient with Chronic Granulomatous Disease

Document Type : case report

Authors

Fatemeh Zakertavalaee ¹

Mohammad Hassan Aelami ¹

Parisa Badiee ²

Hedieh Riyazi ¹

¹ Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

² Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

10.22038/jpp.2026.96488.5681

Abstract

A 4.5-year-old boy was admitted to the hospital with a history of three weeks of fever, cough, and weight loss. He was initially started on empiric treatment for community-acquired pneumonia. Suspicion of tuberculosis led to the addition of anti-tuberculosis therapy. However, his condition further deteriorated, warranting persistent investigations. Chronic granulomatous disease (CGD) and pulmonary aspergillosis were confirmed in the patient by various laboratory tests. He responded quite well to a combination antifungal therapy including liposomal amphotericin B and voriconazole. This case emphasizes that CGD should be considered in patients with recurrent infections caused by opportunistic pathogens.
The current study shows that invasive aspergillosis in CGD can radiologically resemble tuberculosis, which may result in delayed diagnosis. It also demonstrates the effectiveness of rapid diagnostic methods, such as galactomannan and DHR flow cytometry, in resource-limited environments.

Keywords

Chronic Granulomatous Disease

Invasive aspergillosis

Pediatric Immunodeficiency

NADPH Oxidase

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