Invasive pulmonary aspergillosis in an immunocompetent, heavy smoker of marijuana with emphysema and chronic obstructive pulmonary disease

Heavy marijuana smoking has been described a predisposing cause of invasive pulmonary aspergillosis in immunocompromised subjects. This article describes a case of invasive pulmonary aspergillosis in an immunocompetent patient with chronic obstructive pulmonary disease, who was not on maintenance oral corticosteroids and who had been smoking 30 joints per day and developed necrotizing pneumonia. Bronchoalveolar lavage culture was positive for Aspergillus Fumigatus. In the absence of clinical-radiographic response to broad spectrum antibiotic and any other positive culture, treatment with voriconazole was initiated, with resolution of lung cavities and airspace opacities and return to baseline clinical status. Repeat bronchoalveolar lavage was negative for Aspergillus Fumigatus. Invasive pulmonary aspergillosis may be considered in the differential diagnosis of necrotizing pneumonia in heavy smokers of marijuana with chronic lung disease.