Coronavirus Disease-Associated Pulmonary Aspergillosis: A Devastating Complication of COVID-19

Adeel Nasrullah,Anam Javed,Khalid Malik

doi:10.7759/cureus.13004

Abstract

Coronavirus disease-19 (COVID-19) has affected more than ninety-three million people worldwide till January 2021. COVID-19 can cause a destructive dysregulated immune response which can result in numerous complications such as kidney failure, myocarditis, and strokes. A new entity called coronavirus disease-associated pulmonary aspergillosis (CAPA) has emerged in recent times. The literature on CAPA is limited. We present a case of CAPA in an immunocompetent patient who was placed on veno-venous extra-corporeal membranous oxygen (VV-ECMO). We briefly explained pathophysiology, clinical presentations, and management of CAPA in this report.

Highlights

Coronavirus disease-19 (COVID-19) can cause extensive damage to airway epithelial cells due to exaggerated inflammation
We present a case of a fairly healthy gentleman who had a prolonged intensive care unit (ICU) stay due to the need for mechanical ventilation and veno-venous extra-corporeal membranous oxygen (VV-ECMO) for respiratory failure secondary to COVID-19 and superimposed bacterial pneumonia followed by coronavirus disease-associated pulmonary aspergillosis (CAPA)
Though its incidence can be as high as 27.1% in patients with severe acute respiratory distress syndrome (ARDS) and elevated interleukin 6 (IL-6) levels [6]

Summary

Introduction

Coronavirus disease-19 (COVID-19) can cause extensive damage to airway epithelial cells due to exaggerated inflammation. The patient tested positive for COVID-19 through reverse transcriptase-polymerase chain reaction (PCR) testing He received a unit of convalescent plasma, remdesivir 200 mg on day one followed by 100 mg daily for five days, and dexamethasone 6 mg daily for ten days. He continued to have persistent severe hypoxia refractory to non-invasive ventilation and self-proning requiring mechanical ventilation on day ten of hospitalization. Patient symptoms have met the criteria of possible invasive Aspergillosis He received seven days of voriconazole and a repeat second test for aspergillus galactomannan antigen from tracheal aspirate was negative. Citing a protracted disease course characterized by forty-two days of mechanical ventilation and thirty-four days on VV-ECMO without resultant improvement, the patient was transitioned to comfort care and passed away shortly thereafter

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