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[Invasive pulmonary aspergillosis complicating septic shock].

L Nourry1, F Gagnadoux, M Pierrot

  • 1Service de Pneumologie, CHU, Angers, France.

Revue Des Maladies Respiratoires
|November 8, 2005
PubMed
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Invasive pulmonary aspergillosis (IPA) can occur in critically ill patients without prior immunosuppression. Early diagnosis and appropriate antifungal treatment are crucial for successful outcomes in these challenging cases.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Pulmonology

Background:

  • Invasive pulmonary aspergillosis (IPA) is a severe opportunistic infection with high mortality, typically affecting immunocompromised individuals.
  • Prompt diagnosis and management are essential for improving patient prognosis.

Observation:

  • A case of IPA is presented in a 37-year-old woman admitted to the ICU with septic shock and multi-organ failure due to bacterial pneumonia.
  • Deterioration with fever and suggestive lesions on high-resolution computed tomography (HRCT) indicated IPA despite no history of immunosuppression.

Findings:

  • IPA was confirmed by Aspergillus fumigatus isolation and a positive galactomannan test.
  • Initial voriconazole therapy was discontinued due to toxicity; successful treatment was achieved with caspofungin and itraconazole.

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  • HRCT abnormalities resolved, and galactomannan levels normalized over six months.

    • Implications:

    • The diagnosis of IPA should be considered in critically ill patients presenting with septic shock and multi-organ failure, even without apparent immunosuppression.
    • High-resolution computed tomography (HRCT) findings suggestive of IPA warrant further investigation.
    • This case highlights the importance of considering atypical presentations of IPA and adapting antifungal strategies based on patient response and tolerance.