A near fatal case of invasive aspergillosis

Abstract

SummaryBackground:Invasive aspergillosis (IA) rarely presents with endobronchial nodules or pseudomembranes on bronchoscopy. We describe a case of invasive aspergillosis in a patient with systemic lupus erythematosus (SLE), in which a fungal etiology was suspected after visualization of scattered, white endobronchial nodules.Case Report:A 36-year-old-female with history of SLE developed cardiorespiratory shock. Bronchoscopy indicated the presence of endobronchial lesions, and serologic studies were consistent with IA. Given high index of suspicion for fungal disease in an immunocompromised host, empiric antifungals were discontinued and voriconazole initiation resulted in a successful therapy.Conclusions:This case highlights the importance of a high index of suspicion for fungal diseases, especially among critically ill hosts with endobronchial lesions, who develop rapid cardio-respiratory impairment. Failure to recognize endobronchial patterns of fungal infection may lead to treatment delay and adverse clinical outcomes.

The spectrum of pulmonary aspergillosis

“…Patients with IPA are often ill and may exhibit tachycardia, tachypnea and hypoxia [118]. Neutrophil counts can be low, normal or high depending on the underlying immune status and comorbidities of the host.…”

Ovarian aspergilloma in an immunocompetent patient masquerading as ovarian neoplasm

“…Because of varying clinical manifestations, often of a severe nature-Aspergillosis remains a major cause of patient morbidity and is responsible for more than one million mortalities in immunocompromised populations worldwide, annually [ 4 ]. The central nervous system and cardiovascular system may be affected by the direct or hematogenous spread of Aspergillus fungal elements [ 5 - 7 ]. Aspergillosis of the ovary is extremely rare, only a few case studies are reported in the literature [ 8 , 9 ].…”