Invasive chronic pulmonary aspergillosis masquerading as lung malignancy in a patient with asthma and ABPA overlap

Chronic pulmonary aspergillosis (CPA) is a slowly progressive fungal infection that commonly complicates underlying structural lung disease and is frequently misdiagnosed in tuberculosis-endemic regions. Invasive forms of CPA can closely mimic lung malignancy. A man in his late 30s with a history of repeated empirical antitubercular therapy presented with progressive dyspnoea, chronic cough with mucoid sputum, seasonal variation of symptoms and recurrent haemoptysis. Imaging revealed a large right upper lobe mass with mediastinal extension, vascular encasement and complete bronchial obstruction, suggestive of advanced lung cancer. Spirometry showed reversible airflow obstruction, and immunological testing demonstrated markedly elevated total IgE with Aspergillus fumigatus sensitisation. Flexible bronchoscopy revealed an endobronchial growth occluding the right main bronchus. Histopathology confirmed fungal granulomatous inflammation consistent with Aspergillus . Despite antifungal therapy, the patient developed massive haemoptysis and died. This case highlights the diagnostic overlap between CPA, tuberculosis and lung cancer, and emphasises that coexisting asthma or allergic Aspergillus disease does not exclude invasive Aspergillus infection.