Long COVID Complicated by Fatal Cytomegalovirus and Aspergillus Infection of the Lungs: An Autopsy Case Report

Lucia Krivosikova; Tereza Kuracinova; Peter Martanovic; Michaela Hyblova; Jozef Kaluzay; Alexandra Uhrinova; Pavol Janega; Pavel Babal

doi:10.3390/v15091810

Long COVID Complicated by Fatal Cytomegalovirus and Aspergillus Infection of the Lungs: An Autopsy Case Report

Viruses. 2023 Aug 25;15(9):1810. doi: 10.3390/v15091810.

Authors

Lucia Krivosikova¹, Tereza Kuracinova¹, Peter Martanovic², Michaela Hyblova³, Jozef Kaluzay⁴, Alexandra Uhrinova⁵, Pavol Janega^{1

6}, Pavel Babal^{1

3}

Affiliations

¹ Institute of Pathological Anatomy, Faculty of Medicine, Comenius University in Bratislava, 814 99 Bratislava, Slovakia.
² Health Care Surveillance Authority, 829 24 Bratislava, Slovakia.
³ Medirex Group Academy, n.p.o., 949 05 Nitra, Slovakia.
⁴ 4th Department of Internal Medicine, Comenius University in Bratislava, 814 99 Bratislava, Slovakia.
⁵ Agel Radiologia, s.r.o., 811 06 Bratislava, Slovakia.
⁶ Centre of Experimental Medicine, Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, 813 71 Bratislava, Slovakia.

Abstract

After the acute phase of COVID-19, some patients develop long COVID. This term is used for a variety of conditions with a complex, yet not fully elucidated etiology, likely including the prolonged persistence of the virus in the organism and progression to lung fibrosis. We present a unique autopsy case of a patient with severe COVID-19 with prolonged viral persistence who developed interstitial lung fibrosis complicated by a fatal combination of cytomegalovirus and Aspergillus infection. SARS-CoV-2 virus was detected at autopsy in the lungs more than two months after the acute infection, although tests from the nasopharynx were negative. Immune dysregulation after COVID-19 and the administration of corticoid therapy created favorable conditions for the cytomegalovirus and Aspergillus infection that were uncovered at autopsy. These pathogens may represent a risk for opportunistic infections, complicating not only the acute coronavirus infection but also long COVID, as was documented in the presented case.

Keywords: Aspergillus; COVID-19; corticoid therapy; cytomegalovirus; immune dysregulation; long COVID.

Publication types

Case Reports
Research Support, Non-U.S. Gov't

MeSH terms

Aspergillosis* / pathology
Autopsy
COVID-19* / complications
COVID-19* / pathology
Cytomegalovirus
Humans
Lung / pathology
Post-Acute COVID-19 Syndrome
Pulmonary Fibrosis* / pathology
SARS-CoV-2

Grants and funding

This publication has been produced with the support of the Integrated Infrastructure Operational Program for the project: New possibilities for the management of serious diseases in medical and preventive care with regard to the safety of health professionals, ITMS: 313011AUA5, co-financed by the European Regional Development Fund.