Severe Fever with Thrombocytopenia Syndrome Accompanied by Invasive Pulmonary Aspergillosis: An Autopsy Case.

Syunichi Miyauchi,Takumi Kiwaki,Hiroaki Kataoka,Yumi Kariya,Takeshi Kawaguchi,Masatoshi Kimura,Kunihiko Umekita,Akihiko Okayama,Ayako Aizawa,Tsuyoshi Fukushima,Tadaki Suzuki,Mao Rikitake,Kosho Iwao,Ichiro Takajo,Chihiro Iwao,Motohiro Matsuda

doi:10.3390/v13061086

Abstract

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tickborne infectious disease in China, Korea, and Japan caused by the SFTS virus (SFTSV). SFTS has a high mortality rate due to multiorgan failure. Recently, there are several reports on SFTS patients with mycosis. Here, we report a middle-aged Japanese SFTS patient with invasive pulmonary aspergillosis (IPA) revealed by an autopsy. A 61-year-old man with hypertension working in forestry was bitten by a tick and developed fever, diarrhea, and anorexia in 2 days. On day 4, consciousness disorder was appearing, and the patient was transferred to the University of Miyazaki Hospital. A blood test showed leukocytopenia, thrombocytopenia, as well as elevated levels of alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine kinase. The SFTSV gene was detected in serum using a reverse-transcription polymerase chain reaction. On day 5, respiratory failure appeared and progressed rapidly, and on day 7, the patient died. An autopsy was performed that revealed hemophagocytosis in the bone marrow and bleeding of several organs. IPA was observed in lung specimens. SFTSV infection may be a risk factor for developing IPA. Early diagnosis and treatment of IPA may be important in patients with SFTS.

Highlights

Severe fever with thrombocytopenia syndrome virus (SFTSV) is the causative agent of severe fever with thrombocytopenia syndrome (SFTS)
Aspergillus was observed in the gastric mucosa (Figure 5D). According to these pathological findings, the causes of death were considered to be heart failure and respiratory failure. These findings suggested that alveolar hemorrhage, which impacted respiratory failure, might have been associated with the hemorrhagic tendency due to SFTS virus (SFTSV) infection
We reviewed the prevalence of fungal infection and aspergillosis in patients who underwent autopsy [7,8,9,10,11,12,13]

Summary

Introduction

Severe fever with thrombocytopenia syndrome virus (SFTSV) is the causative agent of severe fever with thrombocytopenia syndrome (SFTS). Phlebovirus, Family Bunyaviridae [1], and was renamed “Huaiyangshan banyangvirus” of Banyangvirus Genus of Phenuiviridae Family by the International Committee on Taxonomy of Viruses in 2018 [2]. SFTS is characterized by the sudden onset of a fever, gastrointestinal and neural symptoms, hemorrhagic tendency, thrombocytopenia, and leukocytopenia. It has been suggested that SFTS is associated with mycosis, especially invasive aspergillosis [3,4,5]. The pathogenesis of invasive aspergillosis in SFTS remains unclear. We present an autopsy case of SFTS complicated with invasive pulmonary aspergillosis (IPA)

Case Report

Findings

Discussion

Conclusions