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Published on: December 19, 2020
Double Trouble: COVID-19 Pneumonia Concurrent With COVID-19-Associated Pulmonary Aspergillosis
Komal Khoja1, Samira Samant2, Devesh Kumar2
1Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, kkhoja@mcw.edu.
Introduction:
Severe complications due to COVID-19 are a growing concern. We present a case of COVID-19 pneumonia with development of a superimposed COVID-19-associated pulmonary aspergillosis.
Case Presentation:
A 52-year-old unvaccinated male with a history of asthma and sleep apnea presented with progressive dyspnea 10 days after COVID-19 diagnosis. Worsening respiratory function despite broad-spectrum antibiotics and negative cultures prompted a repeat respiratory culture that revealed Aspergillus; voriconazole was initiated.
Discussion:
The risk of COVID-19-associated pulmonary aspergillosis is highest in patients who are immunosuppressed or who receive corticosteroids to treat COVID-19 infection. Subtle and atypical presentations can be seen; our patient had only mild leukocytosis and progressive dyspnea with a negative initial respiratory culture. COVID-19-associated pulmonary aspergillosis is associated with high morbidity and mortality; thus, prompt diagnosis and treatment may confer a survival benefit.
Conclusions:
Despite the subtle presentation and variable radiographic findings in COVID-19- associated pulmonary aspergillosis, a low clinical threshold for workup is crucial to a timely diagnosis and treatment.
Insights
COVID-19 pneumonia can lead to a dangerous secondary infection called COVID-19-associated pulmonary aspergillosis. Early diagnosis and treatment are crucial for improving patient survival rates.
Area of Science:
- Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Severe complications of COVID-19 (coronavirus disease 2019) are a significant concern.
- This case highlights a rare superimposed infection: COVID-19-associated pulmonary aspergillosis.
Observation:
- A 52-year-old unvaccinated male with asthma and sleep apnea presented with worsening dyspnea 10 days post-COVID-19 diagnosis.
- Initial respiratory cultures were negative, but worsening respiratory function prompted repeat cultures, revealing Aspergillus.
Findings:
- The patient received voriconazole for the Aspergillus infection.
- COVID-19-associated pulmonary aspergillosis presents a high risk for immunosuppressed patients or those on corticosteroids.
- This condition can manifest subtly, with mild leukocytosis and progressive dyspnea, even with initially negative cultures.
Implications:
- Prompt diagnosis and treatment of COVID-19-associated pulmonary aspergillosis are vital for reducing high morbidity and mortality.
- A low threshold for diagnostic workup is essential due to potentially atypical presentations and variable radiographic findings.
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