A rare case of invasive pulmonary aspergillosis in an immunocompetent individual

Abstract

Invasive aspergillosis is a highly lethal opportunistic infection that poses a significant threat to immunocompromised patients. In these patients, the incidence of the disease is increasing, and the mortality rates remain high, so early diagnosis and treatment are very important to improve patient survivability. However, there are few described cases of invasive aspergillosis in immunocompetent patients without any type of comorbidity. We present the case of a 44-year-old immunocompetent woman who presented with a history of productive cough and fever for 1 week. Initially, the clinical and radiological presentation pointed to an infection. Several courses of antibiotics were administrated, with no improvement. Bronchofibroscopy with bronchial biopsies was performed and the bronchoalveolar lavage was negative for all investigations (including fungi). The patient started presenting massive hemoptysis, unresponsive to non-invasive therapies or bronchial artery embolization, requiring pneumonectomy as a life-saving procedure. Definitive diagnosis was made by histological demonstration of tissue invasion by the fungus and growth of Aspergillus in culture. Despite aggressive treatment, the patient is currently under antifungal therapy and respiratory kinesiotherapy, showing great clinical, analytical and radiological improvement. This case emphasizes the importance of maintaining a high index of suspicion and also to remember that invasive aspergillosis can also affect immunocompetent individuals.