Subacute invasive pulmonary aspergillosis following breast cancer treatment: A one-year diagnostic odyssey.

Background: Subacute invasive pulmonary aspergillosis (SIPA) presents diagnostic challenges in post-chemotherapy patients, where persistent respiratory symptoms may be attributed to treatment sequelae rather than opportunistic infection. Recognition is often delayed due to non-specific clinical features and presumed immune recovery following cancer treatment completion. Case presentation: A 39-year-old woman with a history of invasive ductal breast carcinoma developed persistent non-productive cough and intermittent haemoptysis twelve months post-treatment. Despite multiple admissions and empirical therapy over one year, symptoms persisted. Computed tomography (CT) revealed left lower lobe consolidation with cavitation. Diagnosis was established through positive Aspergillus fumigatus PCR and markedly elevated serum Aspergillus IgG (60 NTU; normal <11). Voriconazole treatment achieved clinical improvement and radiological resolution, with 41 % reduction in IgG at four weeks. Conclusion: This case illustrates the prolonged diagnostic odyssey characteristic of SIPA in cancer survivors and emphasises the critical importance of maintaining clinical suspicion for invasive fungal infections beyond the immediate post-chemotherapy period. Molecular diagnostics combined with Aspergillus-specific serology proved superior to conventional methods, whilst serial antibody monitoring provided valuable biomarker-guided treatment assessment. Early recognition and appropriate antifungal therapy can achieve excellent outcomes even after protracted symptomatic periods.