Abstract
Background. Acute aspergillosis is a disease with dramatic progression and high mortality if not treated rapidly. However, diagnosing and treating is challenging, as the risk factors are not fully understood. Case Presentation. A fifty-three-year-old woman without any comorbidities was admitted to hospital due to high fever. Infections with influenza and pneumonia and Staphylococcus aureus bacteremia were diagnosed. The patient improved at first due to antimicrobial therapy; nine days after admission, her clinical condition deteriorated again, and she was transferred to ICU due to septic shock accompanied by respiratory failure, necessitating mechanical ventilation and high-dose catecholamine support. A CT scan showed a resolving inflammatory infiltrate bilateral caverns with markedly thickened walls. A culture from a bronchoalveolar lavage grew Aspergillus fumigatus. Galactomannan testing was positive in a bronchoalveolar lavage sample, and beta-D-glucan was positive in serum. Antifungal therapy with voriconazole and intermittent isavuconazole due to renal failure was performed, followed by a surgical resection of the caverns. Patient’s recovery was complicated by several severe bleeding episodes in the lungs. However, the patient showed full recovery and was discharged after 109 days in hospital. Conclusions. This case report highlights multiple complications of influenza and the difficulties of diagnosing and treating acute pulmonary aspergillosis. Furthermore, it stresses the importance for further studies to deepen the understanding about the association between influenza and aspergillosis and to shed further light on adequate therapy.
Highlights
Acute aspergillosis is a disease with dramatic progression and high mortality if not treated rapidly [1, 2]. e fungal spores of aspergillus are ubiquitous, and most people breathe in fungal spores every day
In people with impaired innate immune system, the fungal spores can overcome the barrier of the respiratory tract and cause a pulmonary infection, known as acute pulmonary aspergillosis (APA)
Ey evaluated 432 patients admitted to seven ICU wards with respiratory failure and confirmed influenza infection and pulmonary infiltrates on imaging. e overall incidence of APA was 19%, and for immunocompromised patients, it was as high as 32%. e overall mortality of patients with APA was significantly higher (51%) than that of patients without APA (28%)
Summary
Acute aspergillosis is a disease with dramatic progression and high mortality if not treated rapidly. A culture from a bronchoalveolar lavage grew Aspergillus fumigatus. Galactomannan testing was positive in a bronchoalveolar lavage sample, and beta-D-glucan was positive in serum. The patient showed full recovery and was discharged after 109 days in hospital. Is case report highlights multiple complications of influenza and the difficulties of diagnosing and treating acute pulmonary aspergillosis. It stresses the importance for further studies to deepen the understanding about the association between influenza and aspergillosis and to shed further light on adequate therapy
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