Abstract Introduction Fungal infections are uncommon causes of pleural effusion, accounting for less than 1% of cases. Among these, Aspergillus niger as an etiological agent is particularly rare. We report a rare case of pleural aspergillosis caused by A. niger in an elderly male, highlighting the importance of considering fungal pathogens in chronic, non-resolving pleural effusions. Case Report A 68-year-old man presented with fever, productive cough, weakness, and loss of appetite for two months. He had a history of diabetes mellitus and smoking. Empirical antitubercular therapy was started due to high suspicion of pulmonary tuberculosis but discontinued after poor response. On evaluation, HRCT chest revealed a right-sided loculated pyopneumothorax with pleural calcifications. Intercostal drainage was performed, and pleural fluid culture demonstrated Aspergillus niger. Routine bacterial cultures were negative. The patient was treated with oral voriconazole, leading to marked clinical and radiological improvement. Discussion and novelty of the case Pleural aspergillosis is usually secondary to pulmonary infection, prior surgery, or immunosuppression. In this case, there was no preceding pulmonary tuberculosis, surgery, or fistula, making it a rare primary pleural infection. Given the history and poor hygiene, one might argue that the oral cavity might have harboured the organism and the patient may have aspirated that into lung, but lack of pulmonary infection and seeding into pleural space are still not explained. Very few cases of aspergillus niger in the pleural fluid have been mentioned in literature. The diagnostic challenge lay in differentiating it from more common causes such as tuberculosis. The successful management with oral voriconazole further underscores the importance of early culture in chronic, non-resolving pleural effusions. Conclusion The diagnosis of aspergillosis as a cause of pleural effusion is not that is usually made unless there is a high index of suspicion based on clinical presentation Fungal pleural effusion. Prompt diagnosis through culture and timely antifungal treatment are crucial for successful outcomes. This abstract is funded by: none
Ullah et al. (Fri,) studied this question.