Invasive pulmonary aspergillosis after influenza a infection in an immunocompetent patient

Abstract

Invasive aspergillosis has emerged as a major cause of life-threatening infections in immunocompromised patients. Recently, patients with chronic obstructive pulmonary disease, who have been receiving corticosteroids for a long period, and immunocompetent patients in the intensive care unit have been identified as nontraditional hosts at risk for invasive aspergillosis. Here, we report a case of invasive pulmonary aspergillosis after influenza in an immunocompetent patient. The patient's symptoms were nonspecific, and the patient was unresponsive to treatments for pulmonary bacterial infection. Bronchoscopy revealed mucosa hyperemia, and wide, raised and cream-colored plaques throughout the trachea and both the main bronchi. Histologic examination revealed aspergillosis. The patient recovered quickly when treated systemically with voriconazole, although the reported mortality rates for aspergillosis are extremely high. This study showed that invasive aspergillosis should be considered in immunocompetent patients who are unresponsive to antibiotic treatments; further, early extensive use of all available diagnostic tools, especially bronchoscopy, is mandatory.

Keywords: Immunocompetence; Influenza A Virus; Invasive Pulmonary Aspergillosis.

Figure 1

(A-D) Chest computed tomography findings. Multifocal ground glass opacities and peribronchial infiltration in both the lungs.

Figure 2

Bronchoscopic examination showing mucosa hyperemia and wide, raised and cream-colored plaques (pseudomembrane formation) through the carina (A) and the right bronchus intermedius (B).

Figure 3

Histologic examination of bronchoscopic biopsy showing numerous branching septate hyphae (PAS stain, ×200).