Fulminant invasive pulmonary aspergillosis in immunocompetent patients—a two-case report

Abstract

Two cases of invasive aspergillosis (IA) in immunocompetent patients with a fulminant fatal outcome are reported. Both patients were elderly and had a history of chronic lung disease treated with prolonged inhaled corticosteroids and a short course of systemic corticosteroids. They presented with dyspnea and fever, their respiratory function deteriorated rapidly, and they died 7 days after admission. Aspergillus fumigatus was cultured from respiratory samples. IA was confirmed in one case by necropsy that showed diffuse bilateral necrotizing pneumonitis and myocarditis. In the other case, IA diagnosis was established by thoracic CT scan plus detection of Aspergillus antigen in two blood samples. These two cases demonstrate that short-term corticosteroid therapy in immunocompetent patients with underlying chronic lung conditions is a risk factor for IA, and that its evolution can be fulminant.

Levitronix Ventricular Assist Devices as a Bridge to Recovery After Profound Biventricular Heart Failure Associated With Pulmonary Aspergillosis

“…In non-immunocompromised patients, fulminant and fatal aspergillus myocarditis can occur after pulse steroid treatment for COPD exacerbation. 29,30 Our patient was not immunocompromised by pre-event steroid use.…”

Invasive Pulmonary Aspergillosis in Patients with Chronic Obstructive Pulmonary Disease: An Emerging Fungal Disease

“…In addition, corticosteroids also directly stimulate the growth of A. fumigatus in vitro, possibly via the sterol binding protein in the fungus [34]. Thus, oral or intravenous corticosteroid treatment of COPD patients appears to be associated with a rising incidence of IPA, and some reports also propose that high doses of inhaled corticosteroids may promote the occurrence of IPA [35][36][37].…”

Pulmonary Fungal Diseases in Immunocompetent Hosts: A Single-Center Retrospective Analysis of 35 Subjects

“…Cases have been reported in the USA, Spain, Germany, France, India, Korea, and Taiwan [7][8][9][10][11][12][13][14]. Unlike immunocompromised patients, pulmonary fungal disease in immunocompetent patients can be easily misdiagnosed due to the absence of the specific clinical and imaging manifestation, as well as a lack of recognition.…”