Diagnosis of pleural aspergillosis caused by Aspergillus infection via metagenomic next-generation sequencing from a patient with unexplained pleural effusion: a case report

Abstract

Pleural aspergillosis is a severe pathological condition triggered by Aspergillus species and commonly affects immunocompromised individuals. This case report describes a 63-year-old man with normal immune function who was admitted to the hospital due to a 20-day history of right-sided chest pain and cough. He was diagnosed with an infection-related pleural effusion of unknown origin. Metagenomic next-generation sequencing (mNGS) identified Aspergillus fumigatus in the pleural effusion intrapleurally, and pathological examination revealed granulomatous inflammation. The patient received three months of antifungal treatment with voriconazole tablets. A six-month follow-up examination showed complete resolution of both pleural and pulmonary abnormalities. This case highlights the utility of mNGS as a diagnostic tool for detecting clinical fungal pathogens with atypical features, thereby improving diagnostic accuracy and therapeutic strategies for such conditions.