A case of Aspergillus quadrilineatus pulmonary infection in China

A 91-year-old Chinese male was hospitalized on June 28, 2021, due to a sudden fever. The patient had a long history of smoking, a 10-year history of type 2 diabetes, a family history of hypertension, and a history of coronary heart disease and lower extremity arterial occlusive disease. He presented with cough, sputum, and dry and wet rales in both lungs. A computed tomography scan revealed multiple infectious lesions in both lungs and a small pleural effusion. His procalcitonin level was 1.75 ng/mL. Microscopic examination of the sputum revealed abundant fungal spores and hyphae. Sputum culture results revealed Aspergillus quadrilineatus, which was confirmed by matrix-assisted laser desorption/ionization time-of-flight and internal transcribed spacer gene sequencing. Fungal drug sensitivity testing revealed that azoles (excluding fluconazole) and echinocandins exhibited high activity against Aspergillus quadrilineatus. The patient's condition improved following intravenous voriconazole treatment for 2 weeks, after which he was discharged. Subsequently, the patient was hospitalized six times for pulmonary infections, with the most recent hospitalization being on March 8, 2024. The symptoms improved, and the patient was discharged on March 15, 2024.