Pulmonary Aspergilloma in a Non-adherent Systemic Lupus Erythematosus Patient Receiving Long-Term Immunosuppression: A Report of a Rare Case.

Pulmonary aspergilloma is an uncommon but potentially life-threatening condition that predominantly affects individuals with pre-existing structural lung disease and immunosuppression. Systemic lupus erythematosus (SLE), especially with long-term immunosuppressive therapy, significantly increases susceptibility to opportunistic infections, including fungal pathogens such as species. These patients are also at heightened risk for a broad range of opportunistic infections, such as species, viral infections such as herpes zoster and cytomegalovirus (CMV), , and pneumonia (PJP). We report a case of a 50-year-old woman with long-standing SLE and poorly controlled diabetes mellitus who developed multilobar pulmonary aspergilloma while on chronic glucocorticoids and azathioprine. Despite initial improvement, she developed hemoptysis, necessitating bronchial artery embolization consideration. Due to extensive bilateral disease, surgical intervention was deferred, and she was successfully managed with prolonged voriconazole therapy. This case underscores the diagnostic and therapeutic challenges of aspergilloma in immunocompromised hosts and highlights the importance of vigilant monitoring and tailored antifungal strategies.