Treatment of Post-COVID-19 Pulmonary Aspergilloma: Insights from a Clinical Case

BACKGROUND This report presents the case of a 49-year-old man with pulmonary aspergilloma 6 months after hospitalization and mechanical ventilation for COVID-19 who was treated with robot-assisted lobectomy. COVID-19-associated pulmonary aspergillosis is a life-threatening complication of SARS-CoV-2 infection. Aspergilloma, a delayed complication of COVID-19, is rare. Major risk factors for pulmonary aspergilloma include neutropenia, solid organ transplantation, prolonged high-dose corticosteroid therapy, hematological malignancy, cytotoxic therapy, acquired immunodeficiency syndrome, and chronic granulomatous disease. Common symptoms include cough, shortness of breath, fatigue, wheezing, weight loss, fever, and chest pain. Hemoptysis is the most severe complication of pulmonary aspergilloma. Treatment options include antifungals, bronchial artery embolization, and surgery. Surgical treatment is considered definitive for patients who do not respond to antifungal medications. CASE REPORT We describe the case of a 49-year-old man with pulmonary aspergilloma who developed a delayed sequela of SARS-CoV-2 infection. He presented to a pulmonary clinic 6 months after a severe COVID-19-related hospitalization, with symptoms of mild hemoptysis, cough, and shortness of breath. A computed tomography scan of the chest revealed a right upper lobe cavitary lesion approximately 9.6×6.1 cm in size. Bronchoalveolar lavage during bronchoscopy revealed Aspergillus fumigatus. The patient did not respond to antifungal treatment and was successfully treated with a robotic-assisted lobectomy. CONCLUSIONS Aspergillus infection should be considered in COVID-19 survivors with pulmonary symptoms. Minimally invasive robotic lobectomy is a feasible option for high-risk patients with post-COVID-19 aspergilloma and hemoptysis who are resistant to medical treatment.