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Peer-reviewedCC BYCureus

A Rare Case of Cystic Bronchiectasis With Concurrent Pulmonary Aspergillosis in a Rheumatoid Arthritis Patient Receiving Etanercept.

  • Hanien Samara1
  • Henrik Ghantarchyan2
  • Twinkle Chandak3
  1. 1Internal Medicine, Harbor-UCLA Medical Center, Torrance, USA.
  2. 2Pulmonary and Critical Care Medicine, Internal Medicine, Arrowhead Regional Medical Center, Colton, USA.
  3. 3Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Loma Linda University Medical Center, Loma Linda, USA.
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Abstract

Tumor necrosis factor-alpha (TNF-α) is critical to the body's ability to mount an appropriate inflammatory and immune response to various infections, particularly against intracellular organisms. As such, the immunosuppressive effects associated with TNF-α inhibitors, such as etanercept, may increase susceptibility to opportunistic infections. We report a case of pulmonary Aspergillus infection in a 47-year-old female with rheumatoid arthritis receiving etanercept who was found to have underlying cystic bronchiectatic changes. The patient presented with progressive exertional dyspnea and was subsequently found to have right lower lobe cystic bronchiectatic changes with mass-like densities on computed tomography (CT) imaging. Sputum fungal culture was positive for Aspergillus, bronchoalveolar lavage (BAL) was positive for Aspergillus antigen, and fungal culture from a bronchoscopic biopsy specimen grew Aspergillus fumigatus. Other infectious evaluations were negative. The patient was treated with voriconazole, and etanercept was discontinued. This case highlights the diagnostic complexity of interpreting Aspergillus isolation in patients with underlying structural lung disease and TNF-α inhibitor exposure.

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Cite

BibTeXRIS
BibTeX
@article{samara2026rare,
  title = {{A Rare Case of Cystic Bronchiectasis With Concurrent Pulmonary Aspergillosis in a Rheumatoid Arthritis Patient Receiving Etanercept.}},
  author = {Hanien Samara and Henrik Ghantarchyan and Twinkle Chandak},
  journal = {Cureus},
  year = {2026},
  month = oct,
  doi = {10.7759/cureus.117349},
  url = {https://europepmc.org/article/MED/42968981},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - A Rare Case of Cystic Bronchiectasis With Concurrent Pulmonary Aspergillosis in a Rheumatoid Arthritis Patient Receiving Etanercept.
AU  - Hanien Samara
AU  - Henrik Ghantarchyan
AU  - Twinkle Chandak
PY  - 2026
DA  - 2026/10/02
JO  - Cureus
DO  - 10.7759/cureus.117349
UR  - https://europepmc.org/article/MED/42968981
AB  - Tumor necrosis factor-alpha (TNF-α) is critical to the body's ability to mount an appropriate inflammatory and immune response to various infections, particularly against intracellular organisms. As such, the immunosuppressive effects associated with TNF-α inhibitors, such as etanercept, may increase susceptibility to opportunistic infections. We report a case of pulmonary Aspergillus infection in a 47-year-old female with rheumatoid arthritis receiving etanercept who was found to have underlying cystic bronchiectatic changes. The patient presented with progressive exertional dyspnea and was subsequently found to have right lower lobe cystic bronchiectatic changes with mass-like densities on computed tomography (CT) imaging. Sputum fungal culture was positive for Aspergillus, bronchoalveolar lavage (BAL) was positive for Aspergillus antigen, and fungal culture from a bronchoscopic biopsy specimen grew Aspergillus fumigatus. Other infectious evaluations were negative. The patient was treated with voriconazole, and etanercept was discontinued. This case highlights the diagnostic complexity of interpreting Aspergillus isolation in patients with underlying structural lung disease and TNF-α inhibitor exposure.
SN  - 2168-8184
ER  -