Fatal COVID-19-Associated Pulmonary Aspergillosis Due to Aspergillus niger Complicated By Pneumothorax: A Case Report

COVID-19-associated pulmonary aspergillosis (CAPA) carries high mortality. Aspergillus niger is not commonly associated with CAPA. A middle-aged woman presented with cough, fever, and dyspnea for ten days and was subsequently diagnosed with COVID-19. She was mechanically ventilated and given methylprednisolone and broad-spectrum antibiotics. The initial computed tomography pulmonary angiogram (CTPA) was negative for pulmonary embolism, yet the patient's condition continued to worsen. A repeat CT scan of the thorax on day 17 revealed two new cavities. Ensuing tracheal culture was positive for Aspergillus niger, and later complicated with pneumothorax. She was treated with amphotericin B, but her clinical course was complicated by a pneumothorax, for which a chest tube was inserted. Despite all efforts, the patient eventually succumbed. Aspergillus niger infection can have devastating consequences in the setting of severe COVID-19 infection. It raises urgent questions about the need for antifungal prophylaxis. Pneumothorax is a potential complication of CAPA, especially when the cavities are very peripheral.