Abstract
Background: Aspergilloma is a common sequela of pulmonary tuberculosis (TB), often forming in cavitary lesions left by the disease. Surgical intervention, such as lobectomy, is the standard treatment for symptomatic or complicated cases. However, this report presents a rare instance of complete resolution of a TB-related aspergilloma complicated by empyema without surgical resection.
Case Presentation: A 57-year-old female with a history of TB treated 10 years before, presented with short ness of breath, dry cough, and recurrent pleural effusions. Imaging revealed a right upper lobe aspergilloma and hydropneumothorax. She underwent chest tube drainage and received antifungal therapy with voriconazole alongside antibiotics. Despite initial improvement, the patient experienced hemoptysis and was advised to undergo surgical resection, but she refused. Over a 3-year follow-up period, the patient showed gradual improvement, and imaging revealed complete resolution of the aspergilloma, with residual scarring only.
Discussion: This case highlights the potential for spontaneous resolution of TB-related aspergilloma in the absence of surgical intervention. While surgical resection remains the standard for complicated aspergillomas, individualized treatment strategies incorporating medical management, drainage, and close monitoring may result in favorable outcomes in selected patients.
Conclusion: This case demonstrates the importance of personalized, patient-centered care in managing TB-related aspergillosis. Non-surgical strategies, when carefully implemented and monitored, may offer a viable alternative to surgery in appropriately selected cases.

Key words: Tuberculosis, pulmonary aspergillosis, pulmonary aspergilloma, empyema, case report.