[Invasive pulmonary aspergillosis complicating septic shock]

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.
• 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.