Surgical Management of an Aspergillus Empyema in a 3-Year-Old Child

Meletios A Kanakis,Lida C Sianidou,Nicholas M Giannopoulos,Sofia Hatzianastasiou,Konstantinos Th Petsios,Dimitrios Bobos,Achilleas Lioulias

doi:10.1155/2020/5179292

Abstract

Aspergillus empyema in nonimmunocompromised children is rare. A case of surgical management of invasive aspergillosis in a previously healthy 3-year-old child is presented. The patient was initially admitted to a hospital with severe respiratory deterioration and clinical instability, originally attributed to sepsis. After surgical intervention and the diagnosis of invasive aspergillosis, intravenous therapy with voriconazole was initiated. During postoperative care, the patient's condition remained stable with mild functional respiratory deficits. The diagnosis and treatment of Aspergillus empyema remains challenging, especially in cases that the recognition of aspergillosis is delayed and urgent surgical management of the empyema is required due to rapid clinical deterioration of the patient. The early initiation, prolonged administration, and close monitoring of high-dose antifungal treatment are highly recommended.

Highlights

Aspergillus empyema following an Aspergillus infection in immunocompetent children is exceedingly rare, and its incidence remains unknown
Aspergillus pleural empyema is usually caused by Aspergillus fumigatus in isolation or occasionally in conjunction with polymicrobial infections
It is debated whether pleural aspergillosis represents an autonomous spontaneous presentation or is a complication of a deep-seated Aspergillus infection

Summary

Introduction

Aspergillus empyema following an Aspergillus infection in immunocompetent children is exceedingly rare, and its incidence remains unknown. It is reported that critically ill children during their intensive care (ICU) stay are at high risk for aspergillosis, even in the absence of immunosuppression, especially children under treatment with corticosteroids or with underlying heart or/ and lung disease [3]. It is debated whether pleural aspergillosis represents an autonomous spontaneous presentation or is a complication of a deep-seated Aspergillus infection. In most cases, the latter seems to hold true. Case Reports in Medicine presented with severe respiratory deterioration and clinical instability, originally attributed to sepsis

Case Presentation

Discussion