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Published on: March 22, 2012
Invasive Subacute Pulmonary Aspergillosis After Puerperal Sepsis: Case Report
Killen H Briones-Claudett1,2,3, Mónica H Briones-Claudett2,3, Roger Alexander Murillo Vasconez2
1Universidad de Guayaquil, Guayaquil, Ecuador.
Abstract:
Subacute invasive aspergillosis is an infection that locally destroys lung parenchyma, and it affects patients with mild immunocompromise. The diagnosis is made by clinical symptoms, imaging, and laboratory results related to the infection. Early diagnosis and treatment is imperative for a favorable patient outcome. In this article, we present the case of a 19-year-old woman who was admitted to the intensive care unit for puerperal sepsis where a hysterectomy was performed. During her hospitalization, she presented atelectasis of the left lung and hemodynamic instability. Chest X-ray and chest computed tomography scan were performed and showed round opacities. It was decided to perform flexible bronchoscopy with bronchoalveolar lavage. An unusual subacute form of implementation of aspergillosis was confirmed by a bronchoalveolar lavage culture that showed the presence of Aspergillus. Images taken during bronchoscopy revealed Aspergillus implantation in the lung and serum galactomannan antigen test was positive. Voriconazole was introduced, 200 mg daily. The patient showed clinical improvement and was discharged from our hospital. We conclude that subacute invasive aspergillosis is a serious infection that can lead to high mortality. Bronchoscopy with bronchoalveolar lavage allows access and effective visualization of the airway as well as sampling for Aspergillus identification.
Insights
Subacute invasive aspergillosis, a serious lung infection, was diagnosed in a post-sepsis patient using bronchoscopy. Early detection and treatment with voriconazole led to a favorable outcome, highlighting the importance of timely intervention.
Area of Science:
- Pulmonology
- Infectious Diseases
- Mycology
Background:
- Subacute invasive aspergillosis is a destructive lung infection affecting immunocompromised individuals.
- Early diagnosis and treatment are crucial for improving patient outcomes.
Observation:
- A 19-year-old woman with puerperal sepsis developed left lung atelectasis and hemodynamic instability.
- Imaging revealed round opacities, leading to flexible bronchoscopy with bronchoalveolar lavage.
- Bronchoscopy confirmed Aspergillus implantation, supported by positive culture and serum galactomannan.
Findings:
- Flexible bronchoscopy with bronchoalveolar lavage enabled direct visualization and sampling.
- Aspergillus was identified in bronchoalveolar lavage cultures.
- Serum galactomannan antigen test was positive, aiding diagnosis.
Implications:
- Subacute invasive aspergillosis is a severe infection with potentially high mortality.
- Bronchoscopy is an effective tool for diagnosing invasive aspergillosis in the lungs.
- Prompt treatment with antifungal agents like voriconazole can lead to clinical improvement.
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