INTRODUCTION:Fungal balls are commonly associated with the Aspergillus species. The hyaline hyphae is not diagnostic of a fungus ball's causative organism hence the need for fungal culture. Systemic fungal infections are rarely seen in immunocompetent persons.

CASE:A 45-year-old male presented with a nine month history of nonproductive cough progressing to hemoptysis. His chest tomography with contrast revealed a mass measuring 6.5cm x 5.5cm x 6.9cm located in the left upper lobe, with a smooth lining and air crescent sign consistent with aspergilloma. Serum galactomannan assay was positive. Patient was treated medically for Aspergillus sp infection with voriconazole and itraconazole for six months with no response. A left upper lobectomy was done. Lung tissue biopsy and histopathologic examination showed hyphal elements with branching short lateral necks. Culture studies revealed a rare microorganism namely Coniochaetta hoffmannii. Post-operatively, our patient improved and was eventually discharged.

DISCUSSION:Coniochaetta hoffmannii is a rare human pathogen and is only implicated in those immunocompromised. Thorough clinical investigation led to the identification of this organism. Literature review reveals scant inconclusive treatment approaches. Surgical intervention proved therapeutic for our patient.

CONCLUSION:Not all fungal balls are caused by Aspergillus sp. Culture studies remains the gold standard in identifying specific organism causing fungus balls. Rare micro-organisms such as Coniochaeta hoffmanii. can be isolated. Invasive fungal infection can occur in an immunocompetent host. The outcome of this study will contribute to the limited pool of information on the diagnosis and management of similar cases.