Proven pulmonary aspergillosis in a COVID-19 patient: A case report

Document Type : Case report

Authors

1 Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

4 Department of Pathology, Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran

5 Central Laboratory, Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran

6 Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

7 Department of Microbiology, Shahr-e-Qods Branch, Islamic Azad University, Tehran, Iran

8 Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Department of Medical Microbiology and Parasitology, College of Health Sciences, Faculty of Clinical Sciences,

10.18502/CMM.7.2.7031

Abstract

Background and Purpose:Coronavirus disease 2019 (COVID-19) becomes a significant clinical challenge in healthcare settings all over the world. Patients with SARS-coronavirus-2 (SARS-CoV-2) infection may experience severe lung damage due to cytokine storming, that predisposing them to fungal infections including "invasive pulmonary aspergillosis”.
Case report:Here, we describe a clinical case of proven pulmonary aspergillosis with Aspergillus tubingensis in a 59-year-old man with a history of hospitalization due to COVID-19 infection. SARS-CoV-2 infection was confirmed by PCR of nasopharyngeal specimens. The first chest computed tomography (CT) revealed a 20 mm in diameter cavitary lesion with intracavitary soft tissue density in the left lung. After 25 days he showed two cavitary lesions in both lungs. Suspicion of fungal infection was raised and the patient underwent a trans-thoracic biopsy of the cavitary lesion. The direct examination and culture of the biopsy material revealed Aspergillus species. Polymerase chain reaction (PCR) and sequencing of the beta-tubulin region was utilized to confirm the Aspergillus species identification. The patient was treated with oral voriconazole for 6 weeks after discharge and we have at least two chest CT scans at the end of the treatment and 2 weeks after treatment.
Conclusion:This report underlines the importance of early diagnosis and management of invasive fungal infections in severe COVID-19 patients.

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