A fatal case of COVID-19-associated invasive pulmonary aspergillosis

Abstract

A 79-year-old Japanese man with polymyalgia rheumatica was admitted to hospital with coronavirus disease (COVID-19). On admission, he was treated with ciclesonide inhalation, ivermectin, and meropenem. He was intubated 6 days after admission, and methylprednisolone therapy was initiated (1000 mg/day). Hypoxemia and chest radiographic findings temporarily improved. However, chest computed tomography showed bilateral ground-glass attenuations, multiple nodules, and consolidation. Aspergillus fumigatus was cultured from the tracheal aspirate and he was diagnosed with COVID-19-associated invasive pulmonary aspergillosis (CAPA) and treated with liposomal amphotericin B. However, he died 28 days after admission.

Keywords: Acute respiratory distress syndrome; COVID-19; COVID-19 associated invasive pulmonary aspergillosis.

Fig. 1

Chest CT on admission. Chest CT showing slight fibrosis bilaterally in the lung bases; there is no evidence of viral pneumonia, such as ground-glass attenuation. CT: computed tomography.

Fig. 2

Chest CT on the 23rd day after admission. Chest CT showing bilateral ground-glass attenuations and an approximately 3-cm nodule in the left lower lung. CT: computed tomography.

Fig. 3

Papanicolaou stain of the tracheal aspirate. A fungus similar to Aspergillus fumigatus was observed on the Papanicolaou stain of the tracheal aspirate ( × 100).

Fig. 4

Clinical course of the patient. MEPM: meropenem; DRPM: doripenem; PZFX: pazufloxacin; L-AMB: liposomal amphotericin B; DEX: dexamethasone; MCFG micafungin; VRC: Voriconazole; mPSL: methylprednisolone; rhTM: recombinant human soluble thrombomodulin.