[Invasive infection by Aspergillus terreus treated successfully with liposomal amphotericin B]

Area of Science:

• Pulmonology
• Infectious Diseases
• Rheumatology

Background:

• Antiphospholipid-antibody syndrome (APS) is an autoimmune disorder associated with an increased risk of thrombosis and pregnancy complications.
• Overlap syndrome, particularly when associated with APS, presents complex diagnostic and therapeutic challenges.

Observation:

• A 75-year-old female patient presented with lower limb weakness and neurological deficits.
• Radiological imaging revealed vertebral fractures, suspected discitis, and bilateral pulmonary infiltrates with cavitation.
• Fungal elements identified in lung biopsy and Aspergillus terreus confirmed in bronchial washings.

Findings:

• The patient was diagnosed with an overlap syndrome associated with antiphospholipid-antibody syndrome.
• Pulmonary Aspergillus terreus infection was successfully treated with liposomal Amphotericin B followed by oral Itraconazole.
• High IgM anticardiolipin antibody (ACA) titers were noted, exceeding those previously reported in literature.

Implications:

• This case highlights the unusual presentation and successful management of Aspergillus terreus pneumonia in an immunocompetent patient with APS.
• The findings underscore the importance of considering opportunistic infections in patients with autoimmune disorders.
• The favorable response to liposomal Amphotericin B contrasts with literature reporting high mortality for invasive aspergillosis.