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Updated: Nov 8, 2025
Histological Quantification to Determine Lung Fungal Burden in Experimental Aspergillosis
Published on: March 9, 2018
A fatal case of COVID-19-associated invasive pulmonary aspergillosis
Yuto Iwanaga1, Toshinori Kawanami1, Kei Yamasaki1
1Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.
Abstract:
A 79-year-old Japanese man with polymyalgia rheumatica was admitted to hospital with coronavirus disease (COVID-19). On admission, he was treated with ciclesonide inhalation, ivermectin, and meropenem. He was intubated 6 days after admission, and methylprednisolone therapy was initiated (1000 mg/day). Hypoxemia and chest radiographic findings temporarily improved. However, chest computed tomography showed bilateral ground-glass attenuations, multiple nodules, and consolidation. Aspergillus fumigatus was cultured from the tracheal aspirate and he was diagnosed with COVID-19-associated invasive pulmonary aspergillosis (CAPA) and treated with liposomal amphotericin B. However, he died 28 days after admission.
Insights
A polymyalgia rheumatica patient with COVID-19 developed invasive pulmonary aspergillosis. Despite treatment, the patient succumbed to the severe fungal coinfection, highlighting a critical clinical challenge.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Polymyalgia rheumatica (PMR) is an inflammatory condition.
- Coronavirus disease (COVID-19) can lead to severe respiratory complications.
- Invasive pulmonary aspergillosis (IPA) is a serious fungal infection.
Observation:
- A 79-year-old male with PMR presented with COVID-19.
- Initial treatments included ciclesonide, ivermectin, and meropenem.
- The patient required intubation and high-dose methylprednisolone therapy.
Findings:
- Chest imaging revealed bilateral ground-glass opacities, nodules, and consolidation.
- Aspergillus fumigatus was identified in tracheal aspirates.
- The patient was diagnosed with COVID-19-associated invasive pulmonary aspergillosis (CAPA).
Implications:
- CAPA represents a severe complication in immunocompromised or critically ill COVID-19 patients.
- Aggressive antifungal therapy with liposomal amphotericin B may be indicated.
- This case underscores the importance of early diagnosis and management of fungal coinfections in severe COVID-19.
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