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[Autopsy case of corticosteroid-induced invasive pulmonary aspergillosis with cavity-formation]

Keishin Sunagawa1, Akihiro Hemmi, Eri Nishikawa

  • 1Department of Pathology, Nihon University School of Medicine, Itabashi-ku, Tokyo 173-8610, Japan. garjyusaiga@yahoo.co.jp

Rinsho Byori. the Japanese Journal of Clinical Pathology
|September 24, 2010
PubMed

Insights

This case study highlights a fatal outcome of invasive pulmonary aspergillosis (IPA) in an elderly patient with idiopathic thrombocytopenic purpura (ITP). Despite aggressive treatment, the patient succumbed to respiratory distress, underscoring IPA

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Pulmonology

Background:

  • Invasive pulmonary aspergillosis (IPA) is a severe complication in immunocompromised patients.
  • High-dose corticosteroids and gamma-globulin therapy are used for conditions like idiopathic thrombocytopenic purpura (ITP).
  • Prognosis for IPA remains poor despite current antifungal treatments.

Observation:

  • An 85-year-old Japanese male with ITP developed respiratory symptoms during treatment.
  • Chest imaging revealed pulmonary infiltration and cavitation.
  • Elevated serum beta-D-glucan and positive Aspergillus antigen confirmed IPA.

Findings:

  • The patient received intensive care, including antifungal drugs and artificial respiration.
  • Despite interventions, he died of respiratory distress on the 68th hospitalization day.
  • Postmortem examination revealed severe bronchopneumonia, lung cavitation, and pulmonary arterial thrombi, with histological evidence of Aspergillus hyphae and vasodestructive fungal growth.

Implications:

  • This case underscores the critical mortality associated with IPA, even in non-neutropenic patients.
  • It highlights the diagnostic challenges and poor prognosis of IPA in elderly patients with underlying conditions.
  • The findings emphasize the need for heightened clinical suspicion and timely diagnosis of IPA in immunocompromised individuals.

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